MEDICARE: MICHAEL LUTZ LPC

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	101YP2500X	Professional Counselor	7740125	WI

General Provider Information

NPI Number	:	1730839325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL LUTZ LPC

Provider Business Mailing Address
First Line	:	2531 N WEIL ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-3024
Country	:	US
Telephone Number	:	414-712-2451
Fax Number	:

Provider Business Practice Location Address
First Line	:	1821 N 16TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53205-1626
Country	:	US
Telephone Number	:	414-977-0001
Fax Number	:

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

Provider Enumeration Date	:	03/25/2022
Last Update Date	:	03/25/2022

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