MEDICARE: MEGHA SHAH THAKKAR PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	51832	CA
2	363A00000X	Physician Assistant	085005751	IL

General Provider Information

NPI Number	:	1386045045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGHA SHAH THAKKAR PA-C

Provider Business Mailing Address
First Line	:	5228 N NORTHWEST HWY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-4620
Country	:	US
Telephone Number	:	773-770-4707
Fax Number	:

Provider Business Practice Location Address
First Line	:	5228 N NORTHWEST HWY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-4620
Country	:	US
Telephone Number	:	773-770-4707
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2014
Last Update Date	:	11/12/2019

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