Provider Demographics
NPI:1295761328
Name:THAKUR, SARVESH SMILEY (MD)
Entity type:Individual
Prefix:
First Name:SARVESH
Middle Name:SMILEY
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 1:5314 189TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-6201
Mailing Address - Country:US
Mailing Address - Phone:206-709-2009
Mailing Address - Fax:206-709-2019
Practice Address - Street 1:2150 N 107TH ST
Practice Address - Street 2:SUITE 520
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-1305
Practice Address - Country:US
Practice Address - Phone:206-709-2009
Practice Address - Fax:206-709-2019
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036801207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1109743Medicaid
WAG83963Medicare UPIN
WA1109743Medicaid