Provider Demographics
NPI:1609986405
Name:THAKORE, VIVEK (BS MS RPT)
Entity Type:Individual
Prefix:
First Name:VIVEK
Middle Name:
Last Name:THAKORE
Suffix:
Gender:M
Credentials:BS MS RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5511 WEST US 10 HWY
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431
Mailing Address - Country:US
Mailing Address - Phone:231-845-0900
Mailing Address - Fax:231-845-0909
Practice Address - Street 1:5511 WEST US 10 HWY
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431
Practice Address - Country:US
Practice Address - Phone:231-845-0900
Practice Address - Fax:231-845-0909
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012678261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy