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NPI Code Detail

MEDICARE: SHIGERU TAKEUCHI ATC

MEDICARE: SHIGERU TAKEUCHI ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer36001300AIN

General Provider Information

NPI Number : 1851401970
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHIGERU TAKEUCHI ATC
Provider Business Mailing Address
First Line : 201 CRAWFORD ST APT 317
Second Line :
City : TERRE HAUTE
State : IN
Zip : 47807-4660
Country : US
Telephone Number : 812-237-7423
Fax Number :
Provider Business Practice Location Address
First Line : ATHLETIC TRAINING DEPARTMENT
Second Line : INDIANA STATE UNIVERSITY
City : TERRE HAUTE
State : IN
Zip : 47809-0001
Country : US
Telephone Number : 812-237-9613
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 07/21/2022

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Directions to “ SHIGERU TAKEUCHI ATC” Practice Location

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