Provider Demographics
NPI:1023215811
Name:LUTTER, LESLIE PATRICK
Entity Type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:PATRICK
Last Name:LUTTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 E FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BRONSON
Mailing Address - State:IA
Mailing Address - Zip Code:51007-5025
Mailing Address - Country:US
Mailing Address - Phone:712-389-7682
Mailing Address - Fax:712-276-2100
Practice Address - Street 1:515 E FRONT ST
Practice Address - Street 2:
Practice Address - City:BRONSON
Practice Address - State:IA
Practice Address - Zip Code:51007-5025
Practice Address - Country:US
Practice Address - Phone:712-389-7682
Practice Address - Fax:712-276-2100
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications