Provider Demographics
NPI:1861488082
Name:PUTZ, JOHN CLEMENS (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CLEMENS
Last Name:PUTZ
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 1:1879 CIMARRON DR
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3811
Mailing Address - Country:US
Mailing Address - Phone:517-349-9240
Mailing Address - Fax:
Practice Address - Street 1:423 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:MI
Practice Address - Zip Code:48811-9741
Practice Address - Country:US
Practice Address - Phone:989-584-6320
Practice Address - Fax:517-364-9130
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301038199207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2003301032OtherBLUE SHIELD IDENTIFIER
MI1960915Medicaid
MI2003301032OtherBLUE SHIELD IDENTIFIER
MI0330103Medicare ID - Type Unspecified