Provider Demographics
NPI:1699394973
Name:LUTTS, MARC WESTON
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:WESTON
Last Name:LUTTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 JOHNS LOOP RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:KY
Mailing Address - Zip Code:42134-5358
Mailing Address - Country:US
Mailing Address - Phone:270-776-7266
Mailing Address - Fax:
Practice Address - Street 1:685 JOHNS LOOP RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:KY
Practice Address - Zip Code:42134-5358
Practice Address - Country:US
Practice Address - Phone:270-776-7266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program