Individual
JENNIFER TAKATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
7322 236TH AVE, SALEM, WI 53168-9664
(262) 671-7560
(262) 671-7565
Mailing address
7322 236TH AVE, SALEM, WI 53168-9664
(262) 671-7560
(262) 671-7565
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036101361
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
49552-21
WI LICENSE
WI
Enumeration date
07/18/2006
Last updated
01/06/2020
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