Provider Demographics
NPI:1912136227
Name:THAKOR, SEJAL (MD)
Entity Type:Individual
Prefix:
First Name:SEJAL
Middle Name:
Last Name:THAKOR
Suffix:
Gender:F
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 1000, DEPT 978
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-758-9900
Mailing Address - Fax:901-752-2335
Practice Address - Street 1:1325 EASTMORELAND AVE STE 150
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3555
Practice Address - Country:US
Practice Address - Phone:901-516-9830
Practice Address - Fax:901-516-9837
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE 7608207Q00000X
TN62820207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine