Provider Demographics
NPI:1306429089
Name:KUTHIALA, ANEEK
Entity type:Individual
Prefix:
First Name:ANEEK
Middle Name:
Last Name:KUTHIALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2798 LOMBARDY CRES
Mailing Address - Street 2:
Mailing Address - City:LASALLE
Mailing Address - State:ON
Mailing Address - Zip Code:N9H 2L7
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2798 LOMBARDY CRES
Practice Address - Street 2:
Practice Address - City:LASALLE
Practice Address - State:ON
Practice Address - Zip Code:N9H 2L7
Practice Address - Country:CA
Practice Address - Phone:586-646-6079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL209028451367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program