Provider Demographics
NPI:1104400720
Name:LUTZ, PAUL M (CHC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:LUTZ
Suffix:
Gender:M
Credentials:CHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5056 LAKE POINT CT
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-6046
Mailing Address - Country:US
Mailing Address - Phone:330-554-6900
Mailing Address - Fax:
Practice Address - Street 1:5056 LAKE POINT CT
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-6046
Practice Address - Country:US
Practice Address - Phone:330-554-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date: