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1053310540

NPI Code Detail

MEDICARE: SEJAL A THAKER M.D.

MEDICARE: SEJAL A THAKER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	036123694	IL
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	036123694	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	202143	OTHER	IL	MEDICARE PTAN
10	709003710	OTHER	RI	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	3238831	OTHER	RI	CIGNA
3	412690	OTHER	RI	BLUE CHIP
4	050483739	OTHER	RI	UNITED HEALTH CARE
5	29951-4	OTHER	RI	BCBS OF RI
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	AA41888	OTHER	RI	HARVARD HEALTH PLAN
8	478831	OTHER	RI	TUFTS HEALTH PLAN
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	31388	OTHER	RI	NEIGHBORHOOD HEALTH PLAN

General Provider Information

NPI Number	:	1053310540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEJAL A THAKER M.D.

Provider Business Mailing Address
First Line	:	3231 EUCLID AVE
Second Line	:	SUITE 405
City	:	BERWYN
State	:	IL
Zip	:	60402-3471
Country	:	US
Telephone Number	:	708-783-2644
Fax Number	:

Provider Business Practice Location Address
First Line	:	3231 EUCLID AVE
Second Line	:	SUITE 405
City	:	BERWYN
State	:	IL
Zip	:	60402-3471
Country	:	US
Telephone Number	:	708-783-2644
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	04/29/2013

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Directions to “ SEJAL A THAKER M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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