Provider Demographics
NPI:1093760142
Name:LUTZ, JAMES T (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:LUTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8498 OWLWOODS LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243-1049
Mailing Address - Country:US
Mailing Address - Phone:513-290-9000
Mailing Address - Fax:
Practice Address - Street 1:4904 WUNNENBERG WAY
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-4985
Practice Address - Country:US
Practice Address - Phone:513-290-9000
Practice Address - Fax:513-671-6718
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350571392083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4135561Medicare ID - Type Unspecified
OHE78458Medicare UPIN
OH2502741Medicaid