Provider Demographics
NPI:1497717185
Name:THAKKAR, VINOD C (MD)
Entity Type:Individual
Prefix:DR
First Name:VINOD
Middle Name:C
Last Name:THAKKAR
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 1:3581 S HIGHLANDS AVE
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-5410
Mailing Address - Country:US
Mailing Address - Phone:863-385-5129
Mailing Address - Fax:863-385-7162
Practice Address - Street 1:3581 S HIGHLANDS AVE
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5410
Practice Address - Country:US
Practice Address - Phone:863-385-5129
Practice Address - Fax:863-385-7162
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0035654207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038565400Medicaid
D53477Medicare UPIN
FL28092Medicare ID - Type Unspecified