Provider Demographics
NPI:1134391410
Name:THAKUR, SHEKHAR C (MD)
Entity type:Individual
Prefix:
First Name:SHEKHAR
Middle Name:C
Last Name:THAKUR
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 2130
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49016-2130
Mailing Address - Country:US
Mailing Address - Phone:269-317-4209
Mailing Address - Fax:269-565-1900
Practice Address - Street 1:231 NORTH AVE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3463
Practice Address - Country:US
Practice Address - Phone:269-565-1111
Practice Address - Fax:269-565-1900
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059115207R00000X
AZ46670207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI103257124Medicaid
MI4301059115OtherSTATE MED LICENSE MICHIGA
BT4312334OtherDEA REGISTR NO
MI4301059115OtherSTATE MED LICENSE MICHIGA
F20228Medicare UPIN
P00050001Medicare PIN