MEDICARE: DEVANSHU HARENDRA THAKORE 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	208M00000X	Hospitalist Physician	C128303	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DA857Z	OTHER	NV	NEW MEDICARE PTAN FROM PALMETTO

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	:	1962476960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVANSHU HARENDRA THAKORE MD

Provider Business Mailing Address
First Line	:	1081 N CHINA LAKE BLVD
Second Line	:
City	:	RIDGECREST
State	:	CA
Zip	:	93555-3130
Country	:	US
Telephone Number	:	760-499-3899
Fax Number	:	760-446-2254

Provider Business Practice Location Address
First Line	:	1081 N CHINA LAKE BLVD
Second Line	:
City	:	RIDGECREST
State	:	CA
Zip	:	93555-3130
Country	:	US
Telephone Number	:	760-446-3551
Fax Number	:	760-446-2254

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	04/13/2026

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