Individual
MR. KYLE A LUTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
520 MARY ST STE 520, EVANSVILLE, IN 47710-1682
(812) 424-8231
(812) 435-8794
Mailing address
520 MARY ST, STE 520, EVANSVILLE, IN 47710-1682
(812) 424-8231
(812) 435-8794
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
10000720A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000335308
ANTHEM BCBS
—
01
—
100000720
INDIANA STATE LICENSE
IN
05
—
300007791
—
IN
05
—
9500485900
—
KY
Enumeration date
10/11/2006
Last updated
03/05/2024
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