Provider Demographics
NPI:1134115173
Name:LUTTS, MINA H (MD)
Entity Type:Individual
Prefix:
First Name:MINA
Middle Name:H
Last Name:LUTTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8859 BROOKSIDE AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-7113
Mailing Address - Country:US
Mailing Address - Phone:513-779-6225
Mailing Address - Fax:513-779-6905
Practice Address - Street 1:8859 BROOKSIDE AVE
Practice Address - Street 2:STE 101
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-7113
Practice Address - Country:US
Practice Address - Phone:513-779-6225
Practice Address - Fax:513-779-6905
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35072174L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2091472Medicaid
OHG86247Medicare UPIN
OH2091472Medicaid