Healthcare Provider Details

I. General information

NPI: 1790748523
Provider Name (Legal Business Name): ANSHU LUTHAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 S CAPITAL OF TEXAS HWY BLD 1 SUITE 500
WEST LAKE HILLS TX
78746-6446
US

IV. Provider business mailing address

PO BOX 19070
GREEN BAY WI
54307-9070
US

V. Phone/Fax

Practice location:
  • Phone: 888-980-0505
  • Fax: 512-485-7393
Mailing address:
  • Phone: 920-496-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD09373
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberQ2236
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number41681-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: