Healthcare Provider Details

I. General information

NPI: 1114410982
Provider Name (Legal Business Name): RACHEL VATSAL THAKORE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7123 W ARCHER AVE
CHICAGO IL
60638-2203
US

IV. Provider business mailing address

2041 GEORGIA AVENUE TOWERS 4300
WASHINGTON DC
20060-0001
US

V. Phone/Fax

Practice location:
  • Phone: 773-586-4506
  • Fax: 630-495-1770
Mailing address:
  • Phone: 202-865-1680
  • Fax: 931-202-8862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036.159687
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: