MEDICARE: DR. KEVIN T 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	207R00000X	Internal Medicine Physician	32791	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110247940	OTHER	CO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01073687101	OTHER	CO	PACIFICARE
3	LULK1114	OTHER	CO	BLUE SHIELD

General Provider Information

NPI Number	:	1578562765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN T LUTZ M.D.

Provider Business Mailing Address
First Line	:	3955 E EXPOSITION AVE
Second Line	:	SUITE 104
City	:	DENVER
State	:	CO
Zip	:	80209-5000
Country	:	US
Telephone Number	:	303-454-2266
Fax Number	:	303-333-8099

Provider Business Practice Location Address
First Line	:	3955 E EXPOSITION AVE
Second Line	:	SUITE 104
City	:	DENVER
State	:	CO
Zip	:	80209-5000
Country	:	US
Telephone Number	:	303-454-2266
Fax Number	:	303-333-8099

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	09/13/2010

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Directions to “ DR. KEVIN T LUTZ M.D.” Practice Location

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