Basic Information
| Provider Information | |||||||||
| NPI: | 1326294745 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THAKKAR | ||||||||
| FirstName: | KAPIL | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4600 S MILL AVE STE 280 | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852826850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803052888 | ||||||||
| FaxNumber: | 4803052889 | ||||||||
| Practice Location | |||||||||
| Address1: | 287 E HUNT HWY STE 105 | ||||||||
| Address2: | |||||||||
| City: | SAN TAN VALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 851435096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806778282 | ||||||||
| FaxNumber: | 4806778283 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2008 | ||||||||
| LastUpdateDate: | 07/25/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 205565 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.