Provider Demographics
NPI:1336190040
Name:THAKKAR, ANAND M (MD)
Entity type:Individual
Prefix:DR
First Name:ANAND
Middle Name:M
Last Name:THAKKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANAND
Other - Middle Name:M
Other - Last Name:SATYADEV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1802 IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-3254
Mailing Address - Country:US
Mailing Address - Phone:630-289-0440
Mailing Address - Fax:
Practice Address - Street 1:1601 TANGLEWOOD AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133-3381
Practice Address - Country:US
Practice Address - Phone:630-289-0440
Practice Address - Fax:630-289-0442
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-112261207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-112261-2Medicaid
ILI26014Medicare UPIN
IL036-112261-2Medicaid
ILIL2670002Medicare PIN
ILIL1084001Medicare PIN
ILIL4207002Medicare PIN
ILIL2564002Medicare PIN
ILK51488Medicare PIN