Basic Information
| Provider Information | |||||||||
| NPI: | 1508877473 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANJANI THAKUR, MD, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 STANDIFORD AVE | ||||||||
| Address2: | SUITE F | ||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953501159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095795628 | ||||||||
| FaxNumber: | 2095795637 | ||||||||
| Practice Location | |||||||||
| Address1: | 840 DELBON AVE | ||||||||
| Address2: | |||||||||
| City: | TURLOCK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953822005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2096614403 | ||||||||
| FaxNumber: | 2096567418 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 05/11/2020 | ||||||||
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| AuthorizedOfficialLastName: | THAKUR | ||||||||
| AuthorizedOfficialFirstName: | ANJANI | ||||||||
| AuthorizedOfficialMiddleName: | KUMAR | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/ MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2096567400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 05/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | A66588 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | DD2771 | 01 | CA | RAILROAD MEDICARE | OTHER | 00A665880 | 05 | CA | MEDICAID | 00A665880 | 01 | CA | BLUE SHIELD | OTHER |