Provider Demographics
NPI:1669683397
Name:THAKKAR, JIGARKUMAR (MD)
Entity Type:Individual
Prefix:
First Name:JIGARKUMAR
Middle Name:
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 1:1309 MACOM DR STE 101
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-3202
Mailing Address - Country:US
Mailing Address - Phone:630-236-8018
Mailing Address - Fax:630-236-8949
Practice Address - Street 1:1309 MACOM DR STE 101
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-3202
Practice Address - Country:US
Practice Address - Phone:630-236-8018
Practice Address - Fax:630-236-8949
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036116848207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00991675OtherRR MEDICARE PTAN
0533210001OtherDMERC
0533210001OtherDMERC
ILP00991675OtherRR MEDICARE PTAN
IL6447860006Medicare NSC