Healthcare Provider Details

I. General information

NPI: 1093906976
Provider Name (Legal Business Name): BHARATH THANKAVEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 GLADES RD STE 460
BOCA RATON FL
33431-6469
US

IV. Provider business mailing address

110 E BROWARD BLVD STE 1100
FORT LAUDERDALE FL
33301-3569
US

V. Phone/Fax

Practice location:
  • Phone: 728-900-8821
  • Fax:
Mailing address:
  • Phone: 561-323-6579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME181395
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: