Individual
DR. KOH TAKEUCHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
115 HEART DR, EAST CAROLINA HEART INSTITUTE AT ECU, GREENVILLE, NC 27834-8944
(252) 744-4400
(252) 744-3987
Mailing address
PO BOX 751069, ECU PHYSICIANS, CHARLOTTE, NC 28275-1069
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
99-7946-99
MA
208600000X
Surgery Physician
2014-00071
NC
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
2014-00071
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1740603018
—
NC
01
—
1847S
BCBS NC
NC
05
—
AC1220007-KT869
—
MA
Enumeration date
01/22/2014
Last updated
05/08/2014
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