Individual
TY LUTZE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1111 W 17TH ST, TULSA, OK 74107-1886
(405) 434-0504
Mailing address
1817 S 15TH ST, BROKEN ARROW, OK 74012-6536
(405) 434-0504
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/11/2025
Last updated
06/11/2025
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