=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215210190
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JIGAR THAKKAR MD SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2011
-----------------------------------------------------
Last Update Date | 12/17/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1309 MACOM DR STE 101
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-236-8018
-----------------------------------------------------
Fax | 630-236-8949
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1309 MACOM DR STE 101
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60564-3202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-236-8018
-----------------------------------------------------
Fax | 630-236-8949
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JIGARKUMAR THAKKAR
-----------------------------------------------------
Credential | M. D.
-----------------------------------------------------
Telephone | 630-236-8018
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 036116848
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------