Provider Demographics
NPI:1508030057
Name:THAKER, POONAM PANKAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:POONAM
Middle Name:PANKAJ
Last Name:THAKER
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:7447 W TALCOTT AVE
Mailing Address - Street 2:SUITE 182
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3745
Mailing Address - Country:US
Mailing Address - Phone:773-792-5155
Mailing Address - Fax:773-594-7975
Practice Address - Street 1:7447 W TALCOTT AVE
Practice Address - Street 2:SUITE 182
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3745
Practice Address - Country:US
Practice Address - Phone:773-792-5155
Practice Address - Fax:773-594-7975
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-116808207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine