Provider Demographics
NPI:1225035173
Name:THINAKKAL, RAM K (MD)
Entity type:Individual
Prefix:
First Name:RAM
Middle Name:K
Last Name:THINAKKAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:521 MEDICAL DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:LIVINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:38570-1879
Mailing Address - Country:US
Mailing Address - Phone:931-403-6101
Mailing Address - Fax:931-403-6102
Practice Address - Street 1:521 MEDICAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570-1879
Practice Address - Country:US
Practice Address - Phone:931-403-6101
Practice Address - Fax:931-403-6102
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN04-27506207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1509617Medicaid
TN1509617Medicaid
TNC45342Medicare UPIN