Provider Demographics
NPI:1952395204
Name:TAKATS, JENIFER MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENIFER
Middle Name:MARIE
Last Name:TAKATS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 COPELAND MILL RD
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8977
Mailing Address - Country:US
Mailing Address - Phone:614-882-0021
Mailing Address - Fax:614-882-1593
Practice Address - Street 1:575 COPELAND MILL RD
Practice Address - Street 2:SUITE 1E
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8977
Practice Address - Country:US
Practice Address - Phone:614-882-0021
Practice Address - Fax:614-882-1593
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350611702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHTA0756061Medicare ID - Type UnspecifiedPHYSICIAN