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Individual

ALISA THAVIKULWAT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
12150 ANNAPOLIS RD STE 111, GLENN DALE, MD 20769-9183
(301) 779-0844
Mailing address
1855 W TAYLOR ST, DEPARTMENT OF OPHTHALMOLOGY, CHICAGO, IL 60612-7242

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
D0087217
MD

Other

Enumeration date
04/01/2015
Last updated
09/24/2020
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