Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 048231 | MI |
NPI | 1144265083 |
---|---|
Provider Name | Edward R Lutkus |
First Address | Ann Arbor, MI 48105-1598 |
Second Address | Saint Joseph, MI 49085-2112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2006 |
Last Update Date | 05/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2585069 | (05) | MI |
3047753 | (05) | MI |
3404097 | (05) | MI |
4700212 | (05) | MI |
4700240 | (05) | MI |
A79103 | (02) | MI |
EL048231 | BC/BS (01) | MI |