Individual
GERALD M TAKALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
751 S 7TH ST, ONTONAGON, MI 49953-1450
(906) 884-4120
(906) 884-2861
Mailing address
751 S 7TH ST, ONTONAGON, MI 49953-1450
(906) 884-4120
(906) 884-2861
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301037981
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0M76190
MEDICARE GROUP
MI
05
—
3520238
—
MI
01
—
MI1614
MEDICARE GROUP
MI
01
—
P00655327
RAILROAD MEDICARE
MI
Enumeration date
10/12/2006
Last updated
12/02/2009
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