Healthcare Provider Details

I. General information

NPI: 1174907752
Provider Name (Legal Business Name): AKANKSHA THAKKAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL CENTER DR
HAZARD KY
41701-9466
US

IV. Provider business mailing address

100 MEDICAL CENTER DR
HAZARD KY
41701-9421
US

V. Phone/Fax

Practice location:
  • Phone: 606-487-7510
  • Fax: 606-487-6793
Mailing address:
  • Phone: 606-439-6600
  • Fax: --

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 Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number56903
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: