Provider Demographics
NPI:1801884226
Name:THAKUR, PRITHVIRAJ S (MD)
Entity type:Individual
Prefix:DR
First Name:PRITHVIRAJ
Middle Name:S
Last Name:THAKUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 31
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62233-0031
Mailing Address - Country:US
Mailing Address - Phone:618-826-4571
Mailing Address - Fax:618-826-3229
Practice Address - Street 1:1315 LEHMEN DR
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:IL
Practice Address - Zip Code:62233-0031
Practice Address - Country:US
Practice Address - Phone:618-826-4571
Practice Address - Fax:618-826-3229
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL65438Medicare ID - Type Unspecified
A14044Medicare UPIN