Provider Demographics
NPI:1790836930
Name:LUTCH, MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:LUTCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5893 COPLEY DR
Mailing Address - Street 2:KAISER PERMANENTE
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-7906
Mailing Address - Country:US
Mailing Address - Phone:858-616-5100
Mailing Address - Fax:858-616-5111
Practice Address - Street 1:5893 COPLEY DR
Practice Address - Street 2:KAISER PERMANENTE
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-7906
Practice Address - Country:US
Practice Address - Phone:858-616-5100
Practice Address - Fax:858-616-5111
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91929207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology