Individual
JUGAL R THAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1302 FRANKLIN AVE STE 3000, NORMAL, IL 61761-6522
(309) 676-8123
(309) 676-8455
Mailing address
420 NE GLEN OAK AVE STE 401, PEORIA, IL 61603-3112
(309) 624-9259
(309) 676-8455
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036164967
IL
207RN0300X
Nephrology Physician
Primary
036164967
IL
Other
Enumeration date
04/02/2018
Last updated
01/16/2025
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