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NPI Code Detail

MEDICARE: WAYNE H LUTZKE

MEDICARE: WAYNE H LUTZKE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice Physician34.001474OH

General Provider Information

NPI Number : 1366437261
Entity Type Code : Individual
Provider Name (Legal Business Name) : WAYNE H LUTZKE
Provider Business Mailing Address
First Line : 4580 STEPHENS CIR NW STE 202
Second Line :
City : CANTON
State : OH
Zip : 44718-3645
Country : US
Telephone Number : 330-754-4431
Fax Number : 330-244-8839
Provider Business Practice Location Address
First Line : 4580 STEPHENS CIR NW STE 202
Second Line :
City : CANTON
State : OH
Zip : 44718-3645
Country : US
Telephone Number : 330-754-4431
Fax Number : 330-244-8839
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2005
Last Update Date : 09/16/2019

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Directions to “ WAYNE H LUTZKE ” Practice Location

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