Healthcare Provider Details

I. General information

NPI: 1225973647
Provider Name (Legal Business Name): LUKE ANHALT
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 LIBERTY VIEW LN
LYNCHBURG VA
24502-2291
US

IV. Provider business mailing address

15671 VINECREST AVE
SPRING LAKE MI
49456-2155
US

V. Phone/Fax

Practice location:
  • Phone: 434-592-6400
  • Fax:
Mailing address:
  • Phone: 616-843-7829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: