MEDICARE: DR. GARY E TAKAHASHI DO

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	207L00000X	Anesthesiology Physician	34006234	OH
2	207L00000X	Anesthesiology Physician	39175	CO

General Provider Information

NPI Number	:	1689645095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY E TAKAHASHI DO

Provider Business Mailing Address
First Line	:	5750 STONE LAKE DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45429-6053
Country	:	US
Telephone Number	:	937-439-5151
Fax Number	:

Provider Business Practice Location Address
First Line	:	3180 KETTERING BLVD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45439-1924
Country	:	US
Telephone Number	:	937-297-6072
Fax Number	:	937-293-0969

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

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	07/08/2007

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