Individual
DR. KEN JULIAN TAKEKOSHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1766 TRAIL RD, MENDOTA HEIGHTS, MN 55118-3730
(651) 756-0038
(651) 389-0175
Mailing address
1766 TRAIL RD, MENDOTA HEIGHTS, MN 55118-3730
(651) 756-0038
(651) 389-0175
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
036-114264
IL
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
4301076830
MI
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
54291
MN
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
56407-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
220F160310
BCBS
MI
05
—
4991871
—
MI
Enumeration date
01/09/2007
Last updated
02/13/2017
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