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General NPI Number Information
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NPI Number | 1598710782
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Entity Type | Individual
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Provider Name | JITENDRA THAKKAR MD
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Gender | Male
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 03/31/2022
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Provider Practice Location Address
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Address Line | 1305 W 18TH ST
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City | SIOUX FALLS
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State | SD
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Zip | 57105-0401
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Country | US
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Telephone | 605-328-4973
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Fax | 605-328-1295
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Provider Business Mailing Address
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Address Line | 1305 W 18TH ST
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City | SIOUX FALLS
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State | SD
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Zip | 57105-0401
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Country | US
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Telephone | 605-328-4973
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Fax | 605-328-1295
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5196
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License Number State | SD
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