Provider Demographics
NPI:1699013953
Name:TAK MEDICAL GROUP, P.C.
Entity Type:Organization
Organization Name:TAK MEDICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:D
Authorized Official - Last Name:FREDETTE.
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-466-4033
Mailing Address - Street 1:48 NELSON ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-2134
Mailing Address - Country:US
Mailing Address - Phone:978-466-4396
Mailing Address - Fax:978-466-4029
Practice Address - Street 1:60 HOSPITAL ROAD.
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-2134
Practice Address - Country:US
Practice Address - Phone:978-466-4396
Practice Address - Fax:978-466-4029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207RC0200X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty