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General NPI Number Information
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NPI Number | 1700290921
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Entity Type | Individual
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Provider Name | AMEET THAKRAR DPM
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Gender | Male
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Dates
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Enumeration Date | 06/16/2014
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Last Update Date | 07/17/2017
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Provider Practice Location Address
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Address Line | 4646 N MARINE DR
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City | CHICAGO
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State | IL
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Zip | 60640-5759
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Country | US
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Telephone | 773-564-5221
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Fax |
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Provider Business Mailing Address
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Address Line | 15772 S BELL RD
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City | HOMER GLEN
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State | IL
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Zip | 60491-8400
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Country | US
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Telephone | 708-301-4443
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Fax | 708-301-4413
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 135000847
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License Number State | IL
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