Healthcare Provider Details

I. General information

NPI: 1023070489
Provider Name (Legal Business Name): KUNJAN P THAKOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5930 W PARKER RD STE 600
PLANO TX
75093-6420
US

IV. Provider business mailing address

5930 W PARKER RD
PLANO TX
75093-6420
US

V. Phone/Fax

Practice location:
  • Phone: 972-378-3242
  • Fax:
Mailing address:
  • Phone: 972-378-3242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberJ8146
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: