Healthcare Provider Details

I. General information

NPI: 1083464853
Provider Name (Legal Business Name): AASHNA THAKUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 W 95TH ST STE 210
OAK LAWN IL
60453-2793
US

IV. Provider business mailing address

1209 CADWELL DR
BLOOMINGTON IL
61704-3683
US

V. Phone/Fax

Practice location:
  • Phone: 312-949-4200
  • Fax: 708-423-1899
Mailing address:
  • Phone: 914-426-1811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125.083575
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: