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General NPI Number Information
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NPI Number | 1114410982
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Entity Type | Individual
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Provider Name | RACHEL VATSAL THAKORE MD
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Gender | Female
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Dates
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Enumeration Date | 06/07/2018
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Last Update Date | 06/15/2022
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Provider Practice Location Address
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Address Line | 7123 W ARCHER AVE
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City | CHICAGO
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State | IL
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Zip | 60638-2203
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Country | US
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Telephone | 773-586-4506
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Fax | 630-495-1770
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Provider Business Mailing Address
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Address Line | 2041 GEORGIA AVENUE TOWERS 4300
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City | WASHINGTON
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State | DC
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Zip | 20060-0001
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Country | US
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Telephone | 202-865-1680
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Fax | 931-202-8862
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 036.159687
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License Number State | IL
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