1538597174 NPI number — VIKRAM THAKAR DPM PA

Table of content: (NPI 1538597174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538597174 NPI number — VIKRAM THAKAR DPM PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIKRAM THAKAR DPM PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538597174
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3338 NE 34TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33308-6906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-358-2363
Provider Business Mailing Address Fax Number:
954-306-2232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3338 NE 34TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33308-6906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-358-2363
Provider Business Practice Location Address Fax Number:
954-303-1779
Provider Enumeration Date:
10/16/2013

Additional Information

Authorized Official

Authorized Official Last Name:
THAKAR
Authorized Official First Name:
VIKRAM
Authorized Official Middle Name:
V
Authorized Official Title or Position:
OWNER ORGANIZATION
Authorized Official Telephone Number:
954-303-1779

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  PO 3557 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 116347000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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