Provider Demographics
NPI:1467461863
Name:THAKKAR, PADMINI (MD)
Entity Type:Individual
Prefix:DR
First Name:PADMINI
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 1:23381 N LONGVIEW PT
Mailing Address - Street 2:
Mailing Address - City:LAKE BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-1983
Mailing Address - Country:US
Mailing Address - Phone:847-381-9757
Mailing Address - Fax:847-381-9759
Practice Address - Street 1:300 FOX GLN
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-1818
Practice Address - Country:US
Practice Address - Phone:847-382-6070
Practice Address - Fax:847-382-6083
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
40734OtherADVOCATE PHO
04900938OtherBLUE CROSS OF IL
04900938OtherBLUE CROSS OF IL
BT0172875OtherDEA NUMBER
ILK20881Medicare ID - Type Unspecified