Provider Demographics
NPI:1285688713
Name:LUETZOW, DEBORAH A (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:LUETZOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:A
Other - Last Name:LUETZOW-FRANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2413 W. RAWSON AVE
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154
Mailing Address - Country:US
Mailing Address - Phone:414-333-0064
Mailing Address - Fax:
Practice Address - Street 1:2413 W RAWSON AVE
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-1323
Practice Address - Country:US
Practice Address - Phone:414-333-0064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29691207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI391703395015OtherBLUE CROSS BLUE SHIELD
WI31555700Medicaid
WI000002800-0001Medicare ID - Type Unspecified
WI31555700Medicaid