Provider Demographics
NPI:1093766370
Name:LUTZ, DONALD CHRIST (DPM)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:CHRIST
Last Name:LUTZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4091 W VIENNA RD
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-9437
Mailing Address - Country:US
Mailing Address - Phone:810-687-7350
Mailing Address - Fax:
Practice Address - Street 1:4091 W VIENNA RD
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420
Practice Address - Country:US
Practice Address - Phone:810-687-7350
Practice Address - Fax:810-687-7360
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDL000819213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4L5255568OtherHEALTHPLUS
MI198382013Medicaid
MI485255568OtherBLUE CROSS BLUE SHIELD
MI0461360001Medicare NSC
MI485255568OtherBLUE CROSS BLUE SHIELD
MI0P25430Medicare PIN