MEDICARE: LARRY W LUTZ M.D.

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
1	207Q00000X	Family Medicine Physician	01027538A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000109173	OTHER	IN	BCBS PIN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386648343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY W LUTZ M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1510
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47706-1510
Country	:	US
Telephone Number	:	812-753-3942
Fax Number	:	812-768-6283

Provider Business Practice Location Address
First Line	:	802 E OAK ST
Second Line	:
City	:	FORT BRANCH
State	:	IN
Zip	:	47648-1666
Country	:	US
Telephone Number	:	812-753-3942
Fax Number	:	812-768-6283

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	01/03/2013

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