MEDICARE: DR. CHARLES MARION LUETJE MD

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	207YX0901X	Otology & Neurotology Physician	31298	MS

General Provider Information

NPI Number	:	1740255876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES MARION LUETJE MD

Provider Business Mailing Address
First Line	:	3100 BROADWAY SUITE 509
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-2413
Country	:	US
Telephone Number	:	816-531-7373
Fax Number	:	816-531-1404

Provider Business Practice Location Address
First Line	:	3100 BROADWAY SUITE 509
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-2413
Country	:	US
Telephone Number	:	816-531-7373
Fax Number	:	816-531-1404

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	12/07/2007

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