Provider Demographics
NPI:1194783480
Name:THAKKAR, MARTA VIVIANA (MD)
Entity type:Individual
Prefix:DR
First Name:MARTA
Middle Name:VIVIANA
Last Name:THAKKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3070 N 51ST ST
Mailing Address - Street 2:STE P309
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1645
Mailing Address - Country:US
Mailing Address - Phone:414-447-2674
Mailing Address - Fax:414-447-2884
Practice Address - Street 1:3070 N 51ST ST
Practice Address - Street 2:STE P309
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1645
Practice Address - Country:US
Practice Address - Phone:414-447-2674
Practice Address - Fax:414-447-2884
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI479422080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34651200Medicaid