Provider Demographics
NPI:1487117248
Name:TAKASAKI, STEPHEN (DO)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:TAKASAKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 W 100 S
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-5881
Mailing Address - Country:US
Mailing Address - Phone:801-798-7301
Mailing Address - Fax:801-798-8513
Practice Address - Street 1:5 E 400 N
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-1347
Practice Address - Country:US
Practice Address - Phone:801-489-8464
Practice Address - Fax:801-798-8513
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13479382-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine