Individual
TIMOTHY TAKACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1525 OAK PARK BLVD, LAKE CHARLES, LA 70601-8849
(337) 494-6767
(337) 494-6750
Mailing address
PO BOX 123453 DEPT 3453, DALLAS, TX 75312-3453
(337) 494-2772
(337) 494-2928
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
331233
LA
390200000X
Student in an Organized Health Care Education/Training Program
309446
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2496328
—
LA
Enumeration date
03/28/2019
Last updated
08/23/2022
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