Healthcare Provider Details

I. General information

NPI: 1902014988
Provider Name (Legal Business Name): DR. ANIL CHANDRA THAKURIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ANIL CHANDRA THAKURIAH MD(MBBS)

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 CHARLEVOIX DR SE STE 200 , COMPHEALTH, PROSPECTIVE EMPLOYER
GRAND RAPIDS MI
49546-7085
US

IV. Provider business mailing address

8195 SANCTUARY DR
COLUMBUS OH
43235-4638
US

V. Phone/Fax

Practice location:
  • Phone: 616-975-5000
  • Fax: 616-975-5030
Mailing address:
  • Phone: 614-848-9425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.048186
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: