Provider Demographics
NPI:1770651846
Name:LUTZ, MARY C (DO)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:LUTZ
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:PO BOX 880618
Mailing Address - Street 2:15TH AND U STREETS UNIVERSITY HEALTH CENTER
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68588-0618
Mailing Address - Country:US
Mailing Address - Phone:402-472-5000
Mailing Address - Fax:402-472-4593
Practice Address - Street 1:15TH AND U STREETS
Practice Address - Street 2:UNIVERSITY HEALTH CENTER
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68588-0618
Practice Address - Country:US
Practice Address - Phone:402-472-5000
Practice Address - Fax:402-472-4593
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NE74207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E58633Medicare UPIN