Doctor Name: | LUTTI PENTON |
NPI Number: | 1073595120 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 19796 |
Business Practice Address: | 420 E Division St Fond Du Lac, WI - 549354560 |
Business Phone Number: | 9209268614 |
Business Fax Number: | |
Mailing Address: | 420 E Division St, FOND DU LAC |
State: | WI |
Postal Code: | 549354560 |
Phone Number: | 9209268340 |
Fax Number: | |
NPI Enumeration Date: | 11/15/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2086S0122X |
License Number: | 19796 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Surgery |
Taxonomy Specialization: | Plastic and Reconstructive Surgery |
Taxonomy Definition: | A surgeon who specializes in plastic and reconstructive surgery. |