Individual
DR. AMINIDHAN D THAKKAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1212 N HIGHWAY 377 STE 119, ROANOKE, TX 76262-6916
(682) 831-1591
Mailing address
1212 N HIGHWAY 377 STE 119, ROANOKE, TX 76262-6916
(682) 831-1591
(682) 831-1598
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
K8519
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
124559902
—
TX
05
—
124559904
—
TX
01
—
85154Y
BCBS
TX
01
—
86796N
BCBS
TX
01
—
930078750
MEDICARE RAILROAD
TX
01
—
930095584
MEDICARE RAILROAD
TX
Enumeration date
01/19/2006
Last updated
06/10/2013
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