Provider Demographics
NPI:1710920160
Name:THACHIL, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:THACHIL
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:13300 HARGRAVE RD
Practice Address - Street 2:STE 190
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4379
Practice Address - Country:US
Practice Address - Phone:281-332-7505
Practice Address - Fax:281-897-1215
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4588207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129003305Medicaid
TX129003307Medicaid
TX8R1567OtherBLUE CROSS OF TEXAS
TX129003302Medicaid
OK100064000AMedicaid
TX129003306Medicaid
TX129003306Medicaid
TXTXB126878Medicare PIN
TX129003307Medicaid
TX8R1567OtherBLUE CROSS OF TEXAS
TX129003302Medicaid
TX87894KMedicare PIN