Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 34008363 | OH |
NPI | 1104024595 |
---|---|
Provider Name | Matthew B Lutz |
First Address | Cuyahoga Falls, OH 44222-0640 |
Second Address | Stow, OH 44224-6841 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2007 |
Last Update Date | 11/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2833349 | (05) | OH |