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General NPI Number Information
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NPI Number | 1285844407
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Entity Type | Individual
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Provider Name | MICHAEL TAKAGI PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 01/03/2014
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Provider Practice Location Address
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Address Line | 422 N MAIN ST
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City | CONDON
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State | OR
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Zip | 97823-7651
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Country | US
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Telephone | 541-384-2061
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Fax |
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Provider Business Mailing Address
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Address Line | 422 N MAIN ST PO BOX 597
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City | CONDON
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State | OR
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Zip | 97823-7651
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Country | US
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Telephone | 541-384-2061
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | AMD-295
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA-791
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | TL 568
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License Number State | WY
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Taxonomy #4
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA-165453
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License Number State | OR
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