Healthcare Provider Details

I. General information

NPI: 1073548483
Provider Name (Legal Business Name): SANJAY A THAKKAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 WEST COUNTRYSIDE PARKWAY
YORKVILLE IL
60560
US

IV. Provider business mailing address

741 LINDSEY LN
BOLINGBROOK IL
60440-6171
US

V. Phone/Fax

Practice location:
  • Phone: 630-882-6441
  • Fax: 630-882-6443
Mailing address:
  • Phone: 630-679-0651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036107028
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: