Provider Demographics
NPI:1962476960
Name:THAKORE, DEVANSHU HARENDRA (MD)
Entity Type:Individual
Prefix:
First Name:DEVANSHU
Middle Name:HARENDRA
Last Name:THAKORE
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 15645
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89114-5645
Mailing Address - Country:US
Mailing Address - Phone:702-560-2894
Mailing Address - Fax:702-560-2928
Practice Address - Street 1:2720 N TENAYA WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0424
Practice Address - Country:US
Practice Address - Phone:702-877-8600
Practice Address - Fax:702-242-7794
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11043208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100503572Medicaid
NVDA857ZOtherNEW MEDICARE PTAN FROM PALMETTO
H89097Medicare UPIN
NV100503572Medicaid