Provider Demographics
NPI:1922466366
Name:TAKEMURA, YOUSUKE (MD, PHD)
Entity Type:Individual
Prefix:PROF
First Name:YOUSUKE
Middle Name:
Last Name:TAKEMURA
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:MIE UNIVERSITY SCHOOL OF MEDICINE, 2-174 EDOBASHI
Mailing Address - Street 2:
Mailing Address - City:TSU
Mailing Address - State:MIE
Mailing Address - Zip Code:5148507
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MIE UNIVERSITY SCHOOL OF MEDICINE, 2-174 EDOBASHI
Practice Address - Street 2:
Practice Address - City:TSU
Practice Address - State:MIE
Practice Address - Zip Code:5148507
Practice Address - Country:JP
Practice Address - Phone:059-231-5290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-30
Last Update Date:2016-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301062719OtherPHYSICIAN LICENSE