Provider Demographics
NPI:1033178819
Name:THAKKAR, BHAVIK V (MD)
Entity Type:Individual
Prefix:
First Name:BHAVIK
Middle Name:V
Last Name:THAKKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1088
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90702-1088
Mailing Address - Country:US
Mailing Address - Phone:562-869-4497
Mailing Address - Fax:562-869-6317
Practice Address - Street 1:11525 BROOKSHIRE AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4985
Practice Address - Country:US
Practice Address - Phone:562-869-4497
Practice Address - Fax:562-869-6317
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48069207R00000X
CAC53926207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110010292Medicare ID - Type Unspecified
I37613Medicare UPIN