Provider Demographics
NPI:1740255876
Name:LUETJE, CHARLES MARION (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MARION
Last Name:LUETJE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3100 BROADWAY SUITE 509
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2413
Mailing Address - Country:US
Mailing Address - Phone:816-531-7373
Mailing Address - Fax:816-531-1404
Practice Address - Street 1:3100 BROADWAY SUITE 509
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2413
Practice Address - Country:US
Practice Address - Phone:816-531-7373
Practice Address - Fax:816-531-1404
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS31298207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSX843455Medicare PIN
C50303Medicare UPIN