Provider Demographics
NPI:1649049958
Name:GLUTOX HEALTH LLC
Entity type:Organization
Organization Name:GLUTOX HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KAKNES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-351-8388
Mailing Address - Street 1:1824 9TH ST SE STE C
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24013-2902
Mailing Address - Country:US
Mailing Address - Phone:540-595-9332
Mailing Address - Fax:
Practice Address - Street 1:1824 9TH ST SE STE C
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24013-2902
Practice Address - Country:US
Practice Address - Phone:540-595-9332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-28
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Multi-Specialty