Provider Demographics
NPI:1104024595
Name:LUTZ, MATTHEW B (DO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:B
Last Name:LUTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44222-0640
Mailing Address - Country:US
Mailing Address - Phone:330-923-0399
Mailing Address - Fax:330-923-6677
Practice Address - Street 1:4275 STEELS POINTE
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-6841
Practice Address - Country:US
Practice Address - Phone:330-923-0399
Practice Address - Fax:330-923-6677
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008363207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2833349Medicaid
H049970Medicare PIN
4646901Medicare PIN
OH2833349Medicaid