Provider Demographics
NPI:1891010799
Name:SHILPA B THAKER MD LTD
Entity Type:Organization
Organization Name:SHILPA B THAKER MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS MGR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LABRECQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-453-3799
Mailing Address - Street 1:3324 CANOE COVE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-6713
Mailing Address - Country:US
Mailing Address - Phone:702-303-2076
Mailing Address - Fax:
Practice Address - Street 1:3150 N TENAYA WAY
Practice Address - Street 2:SUITE 225
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0443
Practice Address - Country:US
Practice Address - Phone:702-558-2111
Practice Address - Fax:702-558-8333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-02
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13297207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV13297OtherNEVADA LIC