Provider Demographics
NPI:1043421209
Name:HATO, TAKASHI (MD)
Entity Type:Individual
Prefix:DR
First Name:TAKASHI
Middle Name:
Last Name:HATO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:SUITE 130 - PROVIDER ENROLLMENT
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:317-274-6374
Mailing Address - Fax:317-274-8575
Practice Address - Street 1:550 UNIVERSITY BLVD
Practice Address - Street 2:UNIVERSITY MEDICAL DIAGNOSTIC ASSOCIATES, INC.
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5149
Practice Address - Country:US
Practice Address - Phone:317-948-0738
Practice Address - Fax:317-944-4319
Is Sole Proprietor?:No
Enumeration Date:2007-05-26
Last Update Date:2021-02-08
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Provider Licenses
StateLicense IDTaxonomies
IN01066087A207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201072400Medicaid
IN201072400Medicaid