=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932195021
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEVIN WILLIAM LUTZ DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2005
-----------------------------------------------------
Last Update Date | 12/23/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 720 E BROAD ST SUITE 100
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43215-3988
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-461-6634
-----------------------------------------------------
Fax | 614-461-7136
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 720 E BROAD ST SUITE 100
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43215-3988
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-461-6634
-----------------------------------------------------
Fax | 614-461-7136
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 36003275
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------