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Individual

TAKAAKI ISHIYAMA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1201 S GRAND BLVD, SAINT LOUIS, MO 63104-1016
(314) 317-0600
(314) 317-0606
Mailing address
SLU CARE ACADEMIC PAVILION, 1008 SOUTH SPRING, SAINT LOUIS, MO 63110-2520
(314) 257-8222
(314) 577-8019

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2008022989
MO
208M00000X
Hospitalist Physician
Primary
2008022989
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1386865822
MO
Enumeration date
05/01/2007
Last updated
02/01/2021
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