Active NPI
Mitava Dipesh Thakkar, DO
- Psychiatry Physician
- Urbana, IL
National Provider Identifier
1003658204
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 125.084241
- Practice address
- 611 W Park St
Urbana, IL 61801-2501 - Phone
- (217) 365-2855
- NPI assigned
- Jun 10, 2024
- Last updated
- Jun 10, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 125.084241 | IL | Primary |
Addresses
Primary practice location
611 W Park St
Urbana, IL 61801-2501
Mailing address
1322 Norwell CT
Schaumburg, IL 60193-2539
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125.084241 | IL | MD | Psychiatry Physician |
Interoperability endpoints
- mthakkardo411765@carlehiedirect.net
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1717977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717977600000",
"number": "1003658204",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1322 NORWELL CT",
"city": "SCHAUMBURG",
"state": "IL",
"postal_code": "601932539"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "611 W PARK ST",
"city": "URBANA",
"state": "IL",
"postal_code": "618012501",
"telephone_number": "217-365-2855"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THAKKAR",
"first_name": "MITAVA",
"middle_name": "DIPESH",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-06-10",
"last_updated": "2024-06-10",
"certification_date": "2024-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "IL",
"license": "125.084241",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Urbana, IL
- Jesse Gabriel Tecson, MD
- Keydi Tejeda, LSW
- Rebecca Terrio, PT
- William S Terry, DT, CERT MDT
- Solomon Teshale, MD
- Samih Zuhair Thalji, MD
- The Care Foundation Hospital (Carle Home Infusion Pharmacy)
- The Care Foundation Hospital (Carle Medical Supply)
- The Carle Foundation Hospital
- The Carle Foundation Hospital (Carle Specialty Pharmacy)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.