MEDICARE: THEODORE SUNAO TAKATA 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	207RC0001X	Clinical Cardiac Electrophysiology Physician	K8508	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00226814	OTHER	TX	RAIL ROAD MEDICARE

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	8M6142	OTHER	TX	BLUE CROSS

General Provider Information

NPI Number	:	1801884382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEODORE SUNAO TAKATA MD

Provider Business Mailing Address
First Line	:	1300 W TERRELL AVE
Second Line	:	#500
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2800
Country	:	US
Telephone Number	:	817-252-5000
Fax Number	:	817-252-5060

Provider Business Practice Location Address
First Line	:	1300 W TERRELL AVE
Second Line	:	#500
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2800
Country	:	US
Telephone Number	:	817-252-5000
Fax Number	:	817-252-5060

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

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	08/15/2011

Similar Medicare Providers

1063409001 — ROBERT DALE ANDERSON MD
Practice Location Address:

1300 W TERRELL AVE , #500
FORT WORTH, TX
76104-2800

Practice Phone: 817-252-5000
Practice Fax: 817-252-5060

1881682607 — JOSEPH MARK ORTENBERG MD
Practice Location Address:

1300 W TERRELL AVE , #500
FORT WORTH, TX
76104-2800

Practice Phone: 817-252-5000
Practice Fax: 817-252-5060

1386632008 — KENNETH WADE MCBRIDE MD
Practice Location Address:

1300 W TERRELL AVE , #500
FORT WORTH, TX
76104-2800

Practice Phone: 817-252-5000
Practice Fax: 817-252-5060

1962490516 — BILLIE RAYMOND PUGH JR. MD
Practice Location Address:

1300 W TERRELL AVE , #500
FORT WORTH, TX
76104-2800

Practice Phone: 817-252-5000
Practice Fax: 817-252-5060

1861471955 — FORT WORTH INSTITUTE FOR CARDIAC CARE
Practice Location Address:

1300 W TERRELL AVE , SUITE 401
FORT WORTH, TX
76104-2800

Practice Phone: 817-252-5070
Practice Fax: 817-252-5072

1497758601 — DR. KATHLEEN M. BALDWIN ANP, GNP, CNS
Practice Location Address:

2800 WEST BOWIE
FORT WORTH, TX
76129-0001

Practice Phone: 817-257-6748
Practice Fax: 817-257-7944

Directions to “ THEODORE SUNAO TAKATA MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.