Provider Demographics
NPI:1376090506
Name:TAKAMOTO, KOJI (MD)
Entity Type:Individual
Prefix:
First Name:KOJI
Middle Name:
Last Name:TAKAMOTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 ABRAHAM FLEXNER WAY SUITE 850
Mailing Address - Street 2:CHRISTINE M. KLEINERT INSTITUTE
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:502-562-0312
Mailing Address - Fax:502-562-0326
Practice Address - Street 1:225 ABRAHAM FLEXNER WAY SUITE 850
Practice Address - Street 2:CHRISTINE M. KLEINERT INSTITUTE
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-562-0312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYFT559390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program