MEDICARE: DR. ROOPAL B THAKKAR 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	207R00000X	Internal Medicine Physician	036-109884	IL

General Provider Information

NPI Number	:	1215266291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROOPAL B THAKKAR M.D.

Provider Business Mailing Address
First Line	:	1050 W KESWICK LN
Second Line	:
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-1138
Country	:	US
Telephone Number	:	847-505-6150
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 W KESWICK LN
Second Line	:
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-1138
Country	:	US
Telephone Number	:	847-505-6150
Fax Number	:

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

Provider Enumeration Date	:	12/21/2009
Last Update Date	:	12/21/2009

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