Provider Demographics
NPI:1386045045
Name:THAKKAR, MEGHA SHAH (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGHA
Middle Name:SHAH
Last Name:THAKKAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5228 N NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-4620
Mailing Address - Country:US
Mailing Address - Phone:773-770-4707
Mailing Address - Fax:
Practice Address - Street 1:5228 N NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-4620
Practice Address - Country:US
Practice Address - Phone:773-770-4707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51832363A00000X
IL085005751363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant