Healthcare Provider Details

I. General information

NPI: 1932195021
Provider Name (Legal Business Name): KEVIN WILLIAM LUTZ DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 12/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 E BROAD ST SUITE 100
COLUMBUS OH
43215-3988
US

IV. Provider business mailing address

720 E BROAD ST SUITE 100
COLUMBUS OH
43215-3988
US

V. Phone/Fax

Practice location:
  • Phone: 614-461-6634
  • Fax: 614-461-7136
Mailing address:
  • Phone: 614-461-6634
  • Fax: 614-461-7136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36003275
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: