Basic Information
| Provider Information | |||||||||
| NPI: | 1497717185 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THAKKAR | ||||||||
| FirstName: | VINOD | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3581 S HIGHLANDS AVE | ||||||||
| Address2: | |||||||||
| City: | SEBRING | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338705410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8633855129 | ||||||||
| FaxNumber: | 8633857162 | ||||||||
| Practice Location | |||||||||
| Address1: | 3581 S HIGHLANDS AVE | ||||||||
| Address2: | |||||||||
| City: | SEBRING | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338705410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8633855129 | ||||||||
| FaxNumber: | 8633857162 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2006 | ||||||||
| LastUpdateDate: | 02/24/2009 | ||||||||
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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 | 207RG0100X | ME0035654 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 038565400 | 05 | FL | MEDICAID |