MEDICARE: HARISH D THAKER MD

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	2084N0400X	Neurology Physician	ME23257	FL
2	208M00000X	Hospitalist Physician	ME23527	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912971086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARISH D THAKER MD

Provider Business Mailing Address
First Line	:	1905 N RIVERSIDE DR
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-1221
Country	:	US
Telephone Number	:	954-854-2951
Fax Number	:

Provider Business Practice Location Address
First Line	:	1211 SE 2ND AVE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-1807
Country	:	US
Telephone Number	:	954-524-6527
Fax Number	:	954-527-3732

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	01/05/2024

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Directions to “ HARISH D THAKER MD” Practice Location

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