Provider Demographics
NPI:1790748523
Name:LUTHAR, ANSHU (MD)
Entity Type:Individual
Prefix:
First Name:ANSHU
Middle Name:
Last Name:LUTHAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19070
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54307-9070
Mailing Address - Country:US
Mailing Address - Phone:920-496-4700
Mailing Address - Fax:
Practice Address - Street 1:1250 S CAPITAL OF TEXAS HWY
Practice Address - Street 2:BLD 1 SUITE 500
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6446
Practice Address - Country:US
Practice Address - Phone:888-980-0505
Practice Address - Fax:512-485-7393
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD09373207Q00000X
TXQ2236208D00000X
WI41681-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000082Medicare Oscar/Certification
RIG42960Medicare UPIN
WI000032Medicare Oscar/Certification
P00697660Medicare Oscar/Certification