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General NPI Number Information
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NPI Number | 1649049958
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Entity Type | Organization
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Legal Business Name | GLUTOX HEALTH LLC
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Dates
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Enumeration Date | 12/28/2023
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 1824 9TH ST SE STE C
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City | ROANOKE
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State | VA
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Zip | 24013-2902
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Country | US
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Telephone | 540-595-9332
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Fax |
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Provider Business Mailing Address
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Address Line | 1824 9TH ST SE STE C
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City | ROANOKE
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State | VA
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Zip | 24013-2902
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Country | US
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Telephone | 540-595-9332
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Fax | 540-766-5456
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | NICHOLAS GEORGE KAKNES
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Credential |
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Telephone | 540-595-9332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RB0002X
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Taxonomy Name | Obesity Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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