Provider Demographics
NPI:1629058169
Name:THAKKAR, AMINIDHAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:AMINIDHAN
Middle Name:D
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 1:1212 N HIGHWAY 377 STE 119
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-6916
Mailing Address - Country:US
Mailing Address - Phone:682-831-1591
Mailing Address - Fax:682-831-1598
Practice Address - Street 1:1212 N HIGHWAY 377 STE 119
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-6916
Practice Address - Country:US
Practice Address - Phone:682-831-1591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8519207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86796NOtherBCBS
TX124559902Medicaid
TX930078750OtherMEDICARE RAILROAD
TX930095584OtherMEDICARE RAILROAD
TX124559904Medicaid
TX85154YOtherBCBS
TX85154YOtherBCBS
TX124559902Medicaid
TX930078750OtherMEDICARE RAILROAD
TX86796NMedicare PIN