Provider Demographics
NPI:1295109825
Name:DR. TAKEM'S WEIGHT LOSS & WELLNESS
Entity type:Organization
Organization Name:DR. TAKEM'S WEIGHT LOSS & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAKEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-481-3184
Mailing Address - Street 1:8401 CONNECTICUT AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-5803
Mailing Address - Country:US
Mailing Address - Phone:301-718-1604
Mailing Address - Fax:
Practice Address - Street 1:8401 CONNECTICUT AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-5803
Practice Address - Country:US
Practice Address - Phone:301-718-1604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD77221207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty