Provider Demographics
NPI:1497738462
Name:LUTZAK, STEPHEN KARIM
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:KARIM
Last Name:LUTZAK
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:KARIM
Other - Middle Name:STEPHEN
Other - Last Name:LUTZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4323 CAROTHERS PARKWAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067
Mailing Address - Country:US
Mailing Address - Phone:615-791-8888
Mailing Address - Fax:
Practice Address - Street 1:4323 CAROTHERS PARKWAY
Practice Address - Street 2:SUITE 300
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067
Practice Address - Country:US
Practice Address - Phone:615-791-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD24074207P00000X, 207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3812453Medicaid
TN3812453Medicare ID - Type Unspecified
TNG60021Medicare UPIN