Provider Demographics
NPI:1245256965
Name:THAKKAR, PARAG (MD)
Entity type:Individual
Prefix:
First Name:PARAG
Middle Name:
Last Name:THAKKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7035
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-7035
Mailing Address - Country:US
Mailing Address - Phone:847-548-9186
Mailing Address - Fax:847-548-1356
Practice Address - Street 1:1170 E BELVIDERE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2061
Practice Address - Country:US
Practice Address - Phone:847-548-9186
Practice Address - Fax:847-548-1356
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-106242207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH29701Medicare UPIN