Provider Demographics
NPI:1871614081
Name:AKEMI TAKEKOSHI, MD., PC
Entity type:Organization
Organization Name:AKEMI TAKEKOSHI, MD., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSCIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:AKEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:TAKEKOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-286-1130
Mailing Address - Street 1:43171 DALCOMA DR
Mailing Address - Street 2:SUITE 11
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6307
Mailing Address - Country:US
Mailing Address - Phone:586-286-1130
Mailing Address - Fax:
Practice Address - Street 1:43171 DALCOMA DR
Practice Address - Street 2:SUITE 11
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-6307
Practice Address - Country:US
Practice Address - Phone:586-286-1130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAT029820174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1003894Medicaid
MIA76325Medicare UPIN
MI0509818Medicare ID - Type Unspecified