Healthcare Provider Details

I. General information

NPI: 1609991959
Provider Name (Legal Business Name): SHILPA BHARAT THAKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 N TENAYA WAY SUITE 225
LAS VEGAS NV
89128-0443
US

IV. Provider business mailing address

3075 RED ARROW DR
LAS VEGAS NV
89135-1625
US

V. Phone/Fax

Practice location:
  • Phone: 702-558-2111
  • Fax: 702-558-8333
Mailing address:
  • Phone: 702-303-2076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number13297
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: