Individual
DEBORAH A LUETZOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2413 W RAWSON AVE, OAK CREEK, WI 53154-1323
(414) 333-0064
Mailing address
2413 W. RAWSON AVE, OAK CREEK, WI 53154
(414) 333-0064
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
29691
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31555700
—
WI
01
—
391703395015
BLUE CROSS BLUE SHIELD
WI
Enumeration date
05/20/2006
Last updated
12/17/2013
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