Provider Demographics
NPI:1437163227
Name:TAKEMOTO, GREG STUART (MD)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:STUART
Last Name:TAKEMOTO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3635 BRADSHAW RD STE B
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-3277
Mailing Address - Country:US
Mailing Address - Phone:916-368-1500
Mailing Address - Fax:916-368-1501
Practice Address - Street 1:3635 BRADSHAW RD STE B
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-3277
Practice Address - Country:US
Practice Address - Phone:916-368-1500
Practice Address - Fax:916-368-1501
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG077070207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG1634Medicare UPIN
CA00G770700Medicare PIN