Provider Demographics
NPI:1407940513
Name:THAKKAR, HEMALINI (MD)
Entity Type:Individual
Prefix:DR
First Name:HEMALINI
Middle Name:
Last Name:THAKKAR
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 1:2015 DEAN ST
Mailing Address - Street 2:#2
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1577
Mailing Address - Country:US
Mailing Address - Phone:630-584-2400
Mailing Address - Fax:630-584-2404
Practice Address - Street 1:2015 DEAN ST
Practice Address - Street 2:#2
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1577
Practice Address - Country:US
Practice Address - Phone:630-584-2400
Practice Address - Fax:630-584-2404
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101070207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036100883Medicaid
IL04532098OtherBC/BS
IL04532098OtherBC/BS
IL036100883Medicaid