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NPI Code Detail

MEDICARE: DR. GEORGE WINSTON LUTZ PH.D.

MEDICARE: DR. GEORGE WINSTON LUTZ PH.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
1103TC0700XClinical PsychologistIL

General Provider Information

NPI Number : 1790709178
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GEORGE WINSTON LUTZ PH.D.
Provider Business Mailing Address
First Line : 95 W GRAND AVE
Second Line : SUITE 205
City : LAKE VILLA
State : IL
Zip : 60046-8641
Country : US
Telephone Number : 847-265-1988
Fax Number :
Provider Business Practice Location Address
First Line : 95 W GRAND AVE
Second Line : SUITE 205
City : LAKE VILLA
State : IL
Zip : 60046-8641
Country : US
Telephone Number : 847-265-1988
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2006
Last Update Date : 07/08/2007

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