1902014988 NPI number — DR. ANIL CHANDRA THAKURIA

Table of content: DR. ANIL CHANDRA THAKURIA (NPI 1902014988)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902014988 NPI number — DR. ANIL CHANDRA THAKURIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THAKURIA
Provider First Name:
ANIL
Provider Middle Name:
CHANDRA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THAKURIAH
Provider Other First Name:
ANIL
Provider Other Middle Name:
CHANDRA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD(MBBS)
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902014988
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8195 SANCTUARY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43235-4638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-848-9425
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 CHARLEVOIX DR SE
Provider Second Line Business Practice Location Address:
STE 200 , COMPHEALTH, PROSPECTIVE EMPLOYER
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49546-7085
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-975-5000
Provider Business Practice Location Address Fax Number:
616-975-5030
Provider Enumeration Date:
05/21/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  35.048186 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)