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1558581702 NPI number — LUTZ E VENTZKE MD A MEDICAL CORPORATION

NPI Number: 1558581702
Health Care Provider/Practitioner: LUTZ E VENTZKE MD A MEDICAL CORPORATION

Information about “1558581702” NPI (LUTZ E VENTZKE MD A MEDICAL CORPORATION) exists in 1558581702 in HTML format HTML  |  1558581702 in plain Text format TXT  |  1558581702 in PDF (Portable Document Format) PDF  |  1558581702 in an XML format XML  formats.

NPI Number : 1558581702 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1558581702",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "LUTZ E VENTZKE MD A MEDICAL CORPORATION",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "22357 MULHOLLAND DRIVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WOODLAND HILLS",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "91364-4934",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "818-704-7248",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "7320 WOODLAKE AVE",
    "SecondLinePracticeLocationAddress": "SUITE 210",
    "PracticeLocationAddressCityName": "WEST HILLS",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "91307-1483",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "818-348-3230",
    "PracticeLocationAddressFaxNumber": "818-883-4496",
    "EnumerationDate": "04/30/2007",
    "LastUpdateDate": "04/30/2008",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "01/30/2008",
    "NPIReactivationDate": "04/30/2008",
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "VENTZKE",
    "AuthorizedOfficialFirstName": "LUTZ",
    "AuthorizedOfficialMiddleName": "EBERHARD",
    "AuthorizedOfficialTitle": "PRESIDENT LUTZ E VENTZKE MD A MEDIC",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "818-704-7248",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207RG0100X",
          "TaxonomyName": "Gastroenterology Physician",
          "LicenseNumber": "A17887",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207R00000X",
          "TaxonomyName": "Internal Medicine Physician",
          "LicenseNumber": "A17887",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        }
      ]
    }
  }
}
                
            

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