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General NPI Number Information
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NPI Number | 1437125424
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Entity Type | Individual
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Provider Name | AMY M LAUTZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/28/2006
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Last Update Date | 08/26/2022
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Provider Practice Location Address
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Address Line | 20611 WATERTOWN ROAD SUITE D & E
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City | BROOKFIELD
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State | WI
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Zip | 53072
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Country | US
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Telephone | 262-256-0676
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Fax |
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Provider Business Mailing Address
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Address Line | 20611 WATERTOWN ROAD SUITE D & E
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City | BROOKFIELD
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State | WI
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Zip | 53072
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Country | US
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Telephone | 262-256-0676
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 47978
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License Number State | WI
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