Individual
PRADEEP V THAKARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1502 S COLORADO ST, GREENVILLE, MS 38703-7219
(662) 332-9872
Mailing address
PO BOX 23998, JACKSON, MS 39225-3998
(662) 725-2749
(662) 725-2741
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
08305
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01636822
—
MS
05
—
1527882
—
LA
01
—
P00258364
RR MEDICARE
—
Enumeration date
08/25/2006
Last updated
09/26/2007
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