Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | 125.066416 | IL |
NPI | 1629452073 |
---|---|
Provider Name | Dr. Justyn Lutfy |
First Address | Springfield, IL 62794-9653 |
Second Address | Springfield, IL 62702-6700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2015 |
Last Update Date | 15/07/2015 |