Healthcare Provider Details

I. General information

NPI: 1285611038
Provider Name (Legal Business Name): STEPHEN T LUTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 08/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15990 MEDICAL DR S
FINDLAY OH
45840-8894
US

IV. Provider business mailing address

PO BOX 330
TOLEDO OH
43697-0330
US

V. Phone/Fax

Practice location:
  • Phone: 419-423-4500
  • Fax:
Mailing address:
  • Phone: 614-430-5712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number35079580L
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: