Provider Demographics
NPI:1891056503
Name:TAKU, SAMUEL TABE
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:TABE
Last Name:TAKU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11430 LOCKWOOD DR APT 203
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2652
Mailing Address - Country:US
Mailing Address - Phone:301-974-4051
Mailing Address - Fax:
Practice Address - Street 1:11430 LOCKWOOD DR APT 203
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2652
Practice Address - Country:US
Practice Address - Phone:301-974-4051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide