MARK THOMAS TAKEO TAKAKI MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036118842

License Status

NOT RENEWED

Business

First Name

MARK THOMAS

Middle

TAKEO

Last Name

TAKAKI

Suffix

Business Name

MARK THOMAS TAKEO TAKAKI MD

Original Issue Date

06/28/2007

Effective Date

07/12/2017

Expiration Date

09/30/2020

City

COEUR D ALENE

State

Zip

83814

County

IDAHO

Ever Disciplined

LastModifiedDate

01/14/2021