Provider Demographics
NPI:1790074334
Name:TAKAGAKI, KENTAROH (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:KENTAROH
Middle Name:
Last Name:TAKAGAKI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BRENNECKESTR. 6
Mailing Address - Street 2:
Mailing Address - City:MAGDEBURG
Mailing Address - State:SACHSEN-ANHALT
Mailing Address - Zip Code:39118
Mailing Address - Country:DE
Mailing Address - Phone:4939162-639-4391
Mailing Address - Fax:
Practice Address - Street 1:BRENNECKESTR. 6
Practice Address - Street 2:
Practice Address - City:MAGDEBURG
Practice Address - State:SACHSEN-ANHALT
Practice Address - Zip Code:39118
Practice Address - Country:DE
Practice Address - Phone:4939162-639-4391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program