Provider Demographics
NPI:1568657146
Name:THAKUR, NITI (MD)
Entity Type:Individual
Prefix:DR
First Name:NITI
Middle Name:
Last Name:THAKUR
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 1:6200 PINE HOLLOW DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-9700
Mailing Address - Country:US
Mailing Address - Phone:517-339-1676
Mailing Address - Fax:517-339-2716
Practice Address - Street 1:6200 PINE HOLLOW DR
Practice Address - Street 2:SUITE 400
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-9700
Practice Address - Country:US
Practice Address - Phone:517-339-1676
Practice Address - Fax:517-339-2716
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301055581207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0331244OtherBLUE CARE NETWORK
MI1103312441OtherBLUE CROSS BLUE SHIELD
MI200000002343OtherPHP
MI10-5214000Medicaid
MIP15480001Medicare PIN
MI200000002343OtherPHP