Provider Demographics
NPI:1104052125
Name:THAKORE, SURUCHI SHAILESH (MD)
Entity type:Individual
Prefix:DR
First Name:SURUCHI
Middle Name:SHAILESH
Last Name:THAKORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7675 WELLNESS WAY
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-2509
Mailing Address - Country:US
Mailing Address - Phone:513-475-7600
Mailing Address - Fax:513-475-7601
Practice Address - Street 1:7675 WELLNESS WAY
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-2509
Practice Address - Country:US
Practice Address - Phone:513-475-7600
Practice Address - Fax:513-475-7601
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X390200000X
OH35 121563207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program