Provider Demographics
NPI:1093400152
Name:THAKKAR, PRIYA MAYUR (DPM)
Entity Type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:MAYUR
Last Name:THAKKAR
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 S WABASH AVE APT 2104
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-1794
Mailing Address - Country:US
Mailing Address - Phone:224-465-4459
Mailing Address - Fax:
Practice Address - Street 1:611 E DOUGLAS RD STE 101
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1464
Practice Address - Country:US
Practice Address - Phone:574-335-6817
Practice Address - Fax:574-335-0732
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program