Individual
MR. MICHAEL TAKAGI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
422 N MAIN ST, CONDON, OR 97823-7651
(541) 384-2061
Mailing address
422 N MAIN ST, PO BOX 597, CONDON, OR 97823-7651
(541) 384-2061
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
AMD-295
HI
363A00000X
Physician Assistant
PA-791
ID
363A00000X
Physician Assistant
TL 568
WY
363AM0700X
Medical Physician Assistant
Primary
PA-165453
OR
Other
Enumeration date
05/23/2007
Last updated
01/03/2014
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