Provider Demographics
NPI:1407814585
Name:LUTFI, EMAN (MD)
Entity Type:Individual
Prefix:MRS
First Name:EMAN
Middle Name:
Last Name:LUTFI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9555 SW BARNES RD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6663
Mailing Address - Country:US
Mailing Address - Phone:503-297-1025
Mailing Address - Fax:503-297-1043
Practice Address - Street 1:9555 SW BARNES RD
Practice Address - Street 2:SUITE 270
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229
Practice Address - Country:US
Practice Address - Phone:503-297-1025
Practice Address - Fax:503-297-1043
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21617208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR287767Medicaid
OR021993011OtherBLUE CROSS
93112982997006A010OtherTRI WEST
OR328715OtherPROVIDENCE HEALTH PLAN