Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 036-111143 | IL |
N | 207X00000X | Orthopaedic Surgeon | DR-45320 | CO |
N | 207X00000X | Orthopaedic Surgeon | L986472 | MI |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 52122-021 | WI |
NPI | 1437123080 |
---|---|
Provider Name | Dr. William B Lutes |
First Address | Kenosha, WI 53142-7884 |
Second Address | Kenosha, WI 53142-7884 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 19/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
209664 | PROVIDER NUMBER CMS (01) | IL |
I14226 | (02) | IL |