Healthcare Provider Details

I. General information

NPI: 1649049958
Provider Name (Legal Business Name): GLUTOX HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1824 9TH ST SE STE C
ROANOKE VA
24013-2902
US

IV. Provider business mailing address

1824 9TH ST SE STE C
ROANOKE VA
24013-2902
US

V. Phone/Fax

Practice location:
  • Phone: 540-595-9332
  • Fax:
Mailing address:
  • Phone: 540-595-9332
  • Fax: 540-766-5456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS GEORGE KAKNES
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 540-595-9332