Provider Demographics
NPI:1750391843
Name:THAKRAR, HARISH V (MD)
Entity type:Individual
Prefix:DR
First Name:HARISH
Middle Name:V
Last Name:THAKRAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 E CHICAGO AVE
Mailing Address - Street 2:# 52 B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2601
Mailing Address - Country:US
Mailing Address - Phone:312-642-6006
Mailing Address - Fax:773-250-0946
Practice Address - Street 1:161 E CHICAGO AVE
Practice Address - Street 2:# 52 B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2601
Practice Address - Country:US
Practice Address - Phone:312-642-6006
Practice Address - Fax:773-250-0946
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360463682085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILBCBS ILLOther2160441535
IL036046368Medicaid
IL474741Medicare ID - Type Unspecified
ILD 12673Medicare UPIN