Provider Demographics
NPI:1578562765
Name:LUTZ, KEVIN T (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:T
Last Name:LUTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3955 E EXPOSITION AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-5000
Mailing Address - Country:US
Mailing Address - Phone:303-454-2266
Mailing Address - Fax:303-333-8099
Practice Address - Street 1:3955 E EXPOSITION AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-5000
Practice Address - Country:US
Practice Address - Phone:303-454-2266
Practice Address - Fax:303-333-8099
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO32791207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01073687101OtherPACIFICARE
CO110247940OtherRAILROAD MEDICARE
COLULK1114OtherBLUE SHIELD
COLULK1114OtherBLUE SHIELD
COF96052Medicare UPIN
COC473478Medicare PIN