Provider Demographics
NPI:1093760142
Name:LUTZ, JAMES T (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:LUTZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:T
Other - Last Name:LUTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1222 S PATTERSON BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-2643
Mailing Address - Country:US
Mailing Address - Phone:937-701-0099
Mailing Address - Fax:833-428-4745
Practice Address - Street 1:1222 S PATTERSON BLVD STE 120
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2643
Practice Address - Country:US
Practice Address - Phone:937-701-0099
Practice Address - Fax:833-428-4745
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350571392083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4135561Medicare ID - Type Unspecified
OHE78458Medicare UPIN
OH2502741Medicaid