Provider Demographics
NPI:1881839090
Name:RAM K THINAKKAL MD
Entity Type:Organization
Organization Name:RAM K THINAKKAL MD
Other - Org Name:FAMILY ENT & ALLERGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:THINAKKAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-403-6101
Mailing Address - Street 1:521 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:38570-1879
Mailing Address - Country:US
Mailing Address - Phone:931-403-6101
Mailing Address - Fax:931-403-6102
Practice Address - Street 1:521 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570-1879
Practice Address - Country:US
Practice Address - Phone:931-403-6101
Practice Address - Fax:931-403-6102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44177207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1509617Medicaid
TNC45342Medicare UPIN
TN1509617Medicaid