Provider Demographics
NPI:1780894725
Name:LUTCHKA, DAVID J (PAC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:LUTCHKA
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3621 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1633
Mailing Address - Country:US
Mailing Address - Phone:734-647-5299
Mailing Address - Fax:
Practice Address - Street 1:515 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1504
Practice Address - Country:US
Practice Address - Phone:734-475-3535
Practice Address - Fax:734-475-0818
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601003333363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION20540Medicare ID - Type Unspecified