Organization
ADULT & PEDIATRIC DERMATOLOGY OF TULLAHOMA PC
Active
Organization
ADULT & PEDIATRIC DERMATOLOGY OF TULLAHOMA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEN T TAKEGAMI MD (PRESIDENT)
(931) 455-7400
Entity
Organization
Contact information
Practice address
100 WILLIAM NORTHERN BLVD, STE C, TULLAHOMA, TN 37388
(931) 455-7400
(931) 455-6344
Mailing address
100 WILLIAM NORTHERN BLVD, STE C, TULLAHOMA, TN 37388
(931) 455-7400
(931) 455-6344
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD0000021099
TN
207ND0101X
MOHS-Micrographic Surgery Physician
MD0000021099
TN
207ND0900X
Dermatopathology Physician
MD0000021099
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3373903
—
TN
Enumeration date
04/13/2006
Last updated
12/03/2009
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up