Provider Demographics
NPI:1538670732
Name:GERIGUIDEMD LLC
Entity type:Organization
Organization Name:GERIGUIDEMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMD/GERIATRICS
Authorized Official - Prefix:DR
Authorized Official - First Name:SONAL
Authorized Official - Middle Name:SONIA
Authorized Official - Last Name:THAKUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-718-3808
Mailing Address - Street 1:19565 ASTER LN
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2111
Mailing Address - Country:US
Mailing Address - Phone:801-718-3808
Mailing Address - Fax:
Practice Address - Street 1:19565 ASTER LN
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2111
Practice Address - Country:US
Practice Address - Phone:801-718-3808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD152920207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000000OtherNO INSURERS YET