Provider Demographics
NPI:1487009551
Name:THAKUR, AJIT SINGH (MD)
Entity Type:Individual
Prefix:MR
First Name:AJIT
Middle Name:SINGH
Last Name:THAKUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 ST. ANTOINE ST
Mailing Address - Street 2:DETROIT EDUCATION AND RESEARCH, GRADUATE MEDICAL EDUCAT
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-993-0034
Mailing Address - Fax:
Practice Address - Street 1:4201 ST. ANTOINE ST
Practice Address - Street 2:DETROIT EDUCATION AND RESEARCH, GRADUATE MEDICAL EDUCAT
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-993-0034
Practice Address - Fax:313-966-0880
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2018-0915207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine