Christopher R Takala, DO
Individual provider Active NPI Child & Adolescent Psychiatry Physician · Milwaukee, WI
NPI 1013203652 · NPPES record last updated Mar 23, 2017
Key facts
- NPI
- 1013203652
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Child & Adolescent Psychiatry Physician 2084P0804X
- License
- 65401 (WI)
- Practice address
- 9000 W Wisconsin Ave
Pediatric Psychiatry
Milwaukee, WI 53226-4874 - Phone
- (414) 607-5280
- NPI assigned
- Jun 22, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160817001929 | WI | Practitioner - Psychiatry |
9032366638 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 65401 | WI | MD | Child & Adolescent Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Medical College of Wisconsin, Inc. | Current |
Accepting new patients | |
| Rogers Memorial Hospital Incorporated | Current |
Accepting new patients | |
| Rogers Behavioral Health - Wisconsin SC | Psychiatry | Current |
Accepting new patients |
Locations
34700 Valley Rd
Oconomowoc, WI 53066
8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100
9000 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 266-2625
11101 W Lincoln Ave
West Allis, WI 53227
Phone (414) 203-4500
2424 S 102nd St
West Allis, WI 53227
Phone (414) 373-7474
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 55474 | MN | |
| Child & Adolescent Psychiatry Physician | 2084P0804X | 65401 | WI | Yes |
Addresses
Primary practice location
9000 W Wisconsin Ave
Pediatric Psychiatry
Milwaukee, WI 53226-4874
Mailing address
9000 W Wisconsin Ave
Pediatric Psychiatry
Milwaukee, WI 53226-4874
Phone (414) 607-5280
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013203652 | Medicaid | WI |
Other providers in Milwaukee, WI
- Taha Medical Center
- Mohamed M Taha
- Sartu Taha
- Janine Elsa Arlene Taitt-Tap
- Alexander Takacs
- Take Care Health Wisconsin, S.C
- Take Control Health Services LLC
- Julie-an M Talano
- Leslie L. Talbert
- Zakareah Talebi
All providers in Milwaukee, WI · Child & Adolescent Psychiatry Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 23, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.