Healthcare Provider Details

I. General information

NPI: 1255434353
Provider Name (Legal Business Name): ANITA THAKUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 N LAKE DRIVE
MILWAUKEE WI
53211
US

IV. Provider business mailing address

13706 N MARTIN WAY
MEQUON WI
53097
US

V. Phone/Fax

Practice location:
  • Phone: 414-291-1989
  • Fax: 414-291-1129
Mailing address:
  • Phone: 262-243-9880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number43392
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number43392
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: