Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0300X | Geriatric Medicine | 0101252586 | VA |
Y | 207RG0300X | Geriatric Medicine | ME150365 | FL |
NPI | 1144579327 |
---|---|
Provider Name | Nirav K. Thakkar |
First Address | Melbourne, FL 32936-1095 |
Second Address | Melbourne, FL 32935-3166 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2012 |
Last Update Date | 23/08/2021 |