Healthcare Provider Details

I. General information

NPI: 1306429089
Provider Name (Legal Business Name): ANEEK KUTHIALA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2798 LOMBARDY CRES
LASALLE ON
N9H 2L7
CA

IV. Provider business mailing address

2006 HOGBACK RD STE 5A
ANN ARBOR MI
48105-9750
US

V. Phone/Fax

Practice location:
  • Phone: 586-646-6079
  • Fax:
Mailing address:
  • Phone: 734-263-2417
  • Fax: 734-773-3741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209028451
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: