Provider Demographics
NPI:1437125424
Name:LAUTZ, AMY M (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:M
Last Name:LAUTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:PARISH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:20611 WATERTOWN ROAD
Mailing Address - Street 2:SUITE D & E
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53072
Mailing Address - Country:US
Mailing Address - Phone:262-256-0676
Mailing Address - Fax:
Practice Address - Street 1:20611 WATERTOWN ROAD
Practice Address - Street 2:SUITE D & E
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53072
Practice Address - Country:US
Practice Address - Phone:262-256-0676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47978208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI01750Medicare ID - Type Unspecified