Provider Demographics
NPI:1629045364
Name:THAKOR, MICHAEL SAMIR (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SAMIR
Last Name:THAKOR
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 1:2121 E HARMONY RD
Mailing Address - Street 2:STE 361
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528
Mailing Address - Country:US
Mailing Address - Phone:970-267-9799
Mailing Address - Fax:970-267-9559
Practice Address - Street 1:2121 E HARMONY RD
Practice Address - Street 2:STE 361
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528
Practice Address - Country:US
Practice Address - Phone:970-267-9799
Practice Address - Fax:970-267-9559
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40814207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49230239Medicaid
COC472838Medicare PIN
COG15516Medicare UPIN