Provider Demographics
NPI:1154323160
Name:SETO, TAKESHI (MD)
Entity type:Individual
Prefix:
First Name:TAKESHI
Middle Name:
Last Name:SETO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 S MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-3543
Mailing Address - Country:US
Mailing Address - Phone:785-242-4465
Mailing Address - Fax:785-242-0211
Practice Address - Street 1:1428 S MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-3543
Practice Address - Country:US
Practice Address - Phone:785-242-4465
Practice Address - Fax:785-242-0211
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0424612207RP1001X, 207R00000X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100155660FMedicaid
KS014010042Medicare PIN