Basic Information
| Provider Information | |||||||||
| NPI: | 1790748523 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUTHAR | ||||||||
| FirstName: | ANSHU | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 19070 | ||||||||
| Address2: | |||||||||
| City: | GREEN BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 543079070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9204964700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1250 S CAPITAL OF TEXAS HWY | ||||||||
| Address2: | BLD 1 SUITE 500 | ||||||||
| City: | WEST LAKE HILLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787466446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8889800505 | ||||||||
| FaxNumber: | 5124857393 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2006 | ||||||||
| LastUpdateDate: | 01/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD09373 | RI | N | Allopathic & Osteopathic Physicians | Family Medicine | 208D00000X | Q2236 | TX | N | Allopathic & Osteopathic Physicians | General Practice | 207Q00000X | 41681-20 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.