Provider Demographics
NPI:1669705687
Name:LUTZ, ANTHONY JOHN (DO)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JOHN
Last Name:LUTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:475-221-8629
Mailing Address - Fax:947-522-0307
Practice Address - Street 1:28080 GRAND RIVER AVE
Practice Address - Street 2:STE. 306 N
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-5966
Practice Address - Country:US
Practice Address - Phone:947-521-4771
Practice Address - Fax:248-473-4772
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101018439207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine