MEDICARE: DR. YUSUKE WAKESHIMA MD

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
1	208100000X	Physical Medicine & Rehabilitation Physician	38757	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215992474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YUSUKE WAKESHIMA MD

Provider Business Mailing Address
First Line	:	2150 W 29TH AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-3844
Country	:	US
Telephone Number	:	303-331-6744
Fax Number	:

Provider Business Practice Location Address
First Line	:	2150 W 29TH AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-3844
Country	:	US
Telephone Number	:	303-331-6744
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	06/17/2011

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