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General NPI Number Information
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NPI Number | 1659538767
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Entity Type | Organization
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Legal Business Name | SHIVENDER K. THAKUR PHYSICIAN PC
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Dates
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Enumeration Date | 05/18/2008
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Last Update Date | 05/18/2008
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Provider Practice Location Address
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Address Line | 890 WESTFALL RD
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City | ROCHESTER
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State | NY
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Zip | 14618-2610
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Country | US
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Telephone | 585-442-6960
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Fax | 585-442-3548
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Provider Business Mailing Address
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Address Line | 890 WESTFALL RD
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City | ROCHESTER
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State | NY
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Zip | 14618-2610
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Country | US
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Telephone | 585-442-6960
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Fax | 585-442-3548
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. SHIVENDER KUMAR THAKUR
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Credential | M.D.
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Telephone | 585-442-6960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 192844
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License Number State | NY
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