Provider Demographics
NPI:1558566703
Name:ALRUTZ, LEWIS JAMES (MD)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:JAMES
Last Name:ALRUTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:
Other - Last Name:ALRUTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:419 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-5540
Mailing Address - Country:US
Mailing Address - Phone:716-433-8140
Mailing Address - Fax:
Practice Address - Street 1:419 WILLOW ST
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-5540
Practice Address - Country:US
Practice Address - Phone:716-433-8140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY91674208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00603723Medicaid
NYB-71095Medicare UPIN