Provider Demographics
NPI:1730594326
Name:LUTZ, JESSICA SUSAN (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:SUSAN
Last Name:LUTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:SUSAN
Other - Last Name:LUTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:825 NE 10TH ST STE 3C
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5417
Mailing Address - Country:US
Mailing Address - Phone:405-271-5239
Mailing Address - Fax:405-271-3727
Practice Address - Street 1:21120 W 152ND ST STE 201
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061
Practice Address - Country:US
Practice Address - Phone:913-491-4020
Practice Address - Fax:913-491-4725
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-41093207V00000X
OK30677207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology