Individual
DAVID J. LUTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7956 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 436-2416
(260) 436-6936
Mailing address
7956 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 436-2416
(260) 436-6936
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
01057270A
IN
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
01057270A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200423930
—
IN
05
—
2386323
—
OH
01
—
250014246
RR MEDICARE
IN
05
—
4835821
—
MI
01
—
P00206255
RR MEDICARE
IN
Enumeration date
06/30/2005
Last updated
08/29/2017
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