Healthcare Provider Details

I. General information

NPI: 1316873136
Provider Name (Legal Business Name): TAKATO HENRY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 ROCHESTER RD
ROYAL OAK MI
48073-3635
US

IV. Provider business mailing address

2512 ROCHESTER RD
ROYAL OAK MI
48073-3635
US

V. Phone/Fax

Practice location:
  • Phone: 248-733-4325
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberH560785336057
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: