MEDICARE: MIDORI TAKEYASU PAR M.D.

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	207P00000X	Emergency Medicine Physician	036094882	IL

General Provider Information

NPI Number	:	1376543199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIDORI TAKEYASU PAR M.D.

Provider Business Mailing Address
First Line	:	1860 PAYSHERE CIRCLE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-0001
Country	:	US
Telephone Number	:	630-469-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	430 WARRENVILLE RD
Second Line	:
City	:	LISLE
State	:	IL
Zip	:	60532-1348
Country	:	US
Telephone Number	:	630-432-6180
Fax Number	:

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	10/10/2017

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