Individual
SUDEEP TAKSALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1600 STATE ST, SALEM, OR 97301-4257
(503) 540-6300
Mailing address
1600 STATE ST, SALEM, OR 97301-4257
(503) 540-6300
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
A100328
CA
207X00000X
Orthopaedic Surgery Physician
Primary
MD155983
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500638495
—
OR
01
—
MD155983
MEDICAL LICENSE
OR
Enumeration date
06/09/2007
Last updated
06/10/2019
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