Provider Demographics
NPI:1487680088
Name:THAKER, KAMLESH (MD)
Entity Type:Individual
Prefix:
First Name:KAMLESH
Middle Name:
Last Name:THAKER
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 1:6565 FANNIN ST
Mailing Address - Street 2:SUITE B452
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2703
Mailing Address - Country:US
Mailing Address - Phone:713-441-3620
Mailing Address - Fax:
Practice Address - Street 1:6565 FANNIN ST
Practice Address - Street 2:SUITE B452
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2703
Practice Address - Country:US
Practice Address - Phone:713-441-3620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9228207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8V3834OtherBLUE CROSS BLUE SHIELD
TXP01030521OtherRR MEDICARE
TX133735412Medicaid
TX133735413Medicaid
TX133735410Medicaid
TX8DY895OtherBLUE CROSS BLUE SHIELD
TXP01333570OtherRR MEDICARE
TX133735411Medicaid
TX616192200OtherUS DEPT OF LABOR
TX133735411Medicaid
TXP01030521OtherRR MEDICARE
TXP01333570OtherRR MEDICARE
NE$$$$$$$$$Medicaid
TX133735412Medicaid
TXTXB138509Medicare PIN