Provider Demographics
NPI:1902821655
Name:LUTTENEGGER, THOMAS JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:LUTTENEGGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:THOMAS
Other - Middle Name:JOSEPH
Other - Last Name:LUTTENEGGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3248 NELSON LN
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2861
Mailing Address - Country:US
Mailing Address - Phone:970-226-2666
Mailing Address - Fax:970-226-3988
Practice Address - Street 1:3248 NELSON LN
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2861
Practice Address - Country:US
Practice Address - Phone:970-226-2666
Practice Address - Fax:970-226-3988
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO221332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E23305Medicare UPIN