Provider Demographics
NPI:1053310540
Name:THAKER, SEJAL A (MD)
Entity Type:Individual
Prefix:
First Name:SEJAL
Middle Name:A
Last Name:THAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 EUCLID AVE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3471
Mailing Address - Country:US
Mailing Address - Phone:708-783-2644
Mailing Address - Fax:
Practice Address - Street 1:3231 EUCLID AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3471
Practice Address - Country:US
Practice Address - Phone:708-783-2644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036123694207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL202143OtherMEDICARE PTAN
RI3238831OtherCIGNA
RI412690OtherBLUE CHIP
RI050483739OtherUNITED HEALTH CARE
RI29951-4OtherBCBS OF RI
RI7057835Medicaid
RIAA41888OtherHARVARD HEALTH PLAN
RI478831OtherTUFTS HEALTH PLAN
IL036123694Medicaid
RI709003710OtherMEDICARE GROUP
RI31388OtherNEIGHBORHOOD HEALTH PLAN
RI709003710OtherMEDICARE GROUP
RI7057835Medicaid