Provider Demographics
NPI:1376855791
Name:THAWANI, NEELAM (PT)
Entity type:Individual
Prefix:
First Name:NEELAM
Middle Name:
Last Name:THAWANI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NEELAM
Other - Middle Name:
Other - Last Name:KARAMCHANDANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2001 BUTTERFIELD RD STE 1600
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10636 W 7 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-1969
Practice Address - Country:US
Practice Address - Phone:313-862-1340
Practice Address - Fax:313-862-1329
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015202225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501015202OtherMI LICENCE NUMBER
MI0F39911OtherBCBSM PIN