Individual provider Active NPI

Gabriel Takuh

  • Family Nurse Practitioner
  • Portage, MI
National Provider Identifier
1790355907
Registry record updated Jun 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704281691 Issued in MI
Practice address
1588 Drayton CT
Portage, MI 49002-7293
Phone
(269) 779-6415
NPI assigned
Jun 29, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 29, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704281691 MI Primary

Addresses

Primary practice location

1588 Drayton CT
Portage, MI 49002-7293

Mailing address

1588 Drayton CT
Portage, MI 49002-7293
Phone (269) 779-6415

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230717000582 MI Practitioner - Nurse Practitioner 3173983608 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Complexcare Medical Group Midwest H PLLC CurrentSince Jun 10, 2025 Accepting new patients
Theoria Medical CurrentSince May 22, 2023 Accepting new patients
Complexcare Medical Group Midwest M PLLC CurrentSince Sep 21, 2025 Accepting new patients

Locations

5655 Clarkston Rd
Clarkston, MI 48348
Phone (810) 623-5216

6700 W Outer Dr
Detroit, MI 48235
Phone (313) 836-1700

3139 E Baldwin Rd
Grand Blanc, MI 48439
Phone (810) 445-5300

2575 N Drake Rd
Kalamazoo, MI 49006
Phone (269) 342-0206

41800 W 11 Mile Rd
Ste 109
Novi, MI 48375
Phone (833) 578-2763

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1624924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624924800000",
    "number": "1790355907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1588 DRAYTON CT",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490027293",
            "telephone_number": "269-779-6415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1588 DRAYTON CT",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490027293",
            "telephone_number": "269-779-6415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAKUH",
        "first_name": "GABRIEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-06-29",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704281691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, MI

Sources for this page

Verify at the official NPI Registry.