Individual
COLLEEN MICHELLE TAKAGISHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
2650 RIDGE AVE, DIVISION OF HEMATOLOGY-ONCOLOGY, EVANSTON, IL 60201-1718
(888) 909-5222
(847) 570-2336
Mailing address
2650 RIDGE AVE, EVANSTON HOSPITAL, EVANSTON, IL 60201-1718
(847) 570-1206
(847) 570-1248
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164-000805
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
164-000805
IL STATE LIC
IL
Enumeration date
01/03/2007
Last updated
02/25/2010
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