Healthcare Provider Details

I. General information

NPI: 1437123080
Provider Name (Legal Business Name): WILLIAM B LUTES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 104TH AVE STE 110
KENOSHA WI
53142-7845
US

IV. Provider business mailing address

7401 104TH AVE STE 110
KENOSHA WI
53142-7845
US

V. Phone/Fax

Practice location:
  • Phone: 262-764-5595
  • Fax: 262-764-9314
Mailing address:
  • Phone: 262-764-5595
  • Fax: 262-764-9314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number52122-021
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number52122-021
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: