Basic Information
| Provider Information | |||||||||
| NPI: | 1518951888 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAKEDAI | ||||||||
| FirstName: | TEIICHI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 LOTHROP ST | ||||||||
| Address2: | FORBES TOWER ROOM 9055 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152132536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128028271 | ||||||||
| FaxNumber: | 4126474486 | ||||||||
| Practice Location | |||||||||
| Address1: | 5215 CENTRE AVE | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152321303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126232287 | ||||||||
| FaxNumber: | 4126236629 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2005 | ||||||||
| LastUpdateDate: | 08/15/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD434173 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 52347 | 01 | IN | SIHO | OTHER | 200512590 | 05 | IN | MEDICAID |