Provider Demographics
NPI:1548475361
Name:LUTZ, TED J (HEARING AID DEALER)
Entity type:Individual
Prefix:MR
First Name:TED
Middle Name:J
Last Name:LUTZ
Suffix:
Gender:M
Credentials:HEARING AID DEALER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 N JEBAVY DR
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-1923
Mailing Address - Country:US
Mailing Address - Phone:231-843-7019
Mailing Address - Fax:231-843-7019
Practice Address - Street 1:325 N JEBAVY DR
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1923
Practice Address - Country:US
Practice Address - Phone:231-843-7019
Practice Address - Fax:231-843-7019
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI540E30879174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540E30879OtherHEARING AID DEALER