Healthcare Provider Details

I. General information

NPI: 1699076976
Provider Name (Legal Business Name): EMERGENCY MEDICINE PHYSICIANS OF HONOLULU PALI MOMI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1079 MOANALUA RD
AIEA HI
96701-4713
US

IV. Provider business mailing address

4535 DRESSLER RD NW
CANTON OH
44718-2545
US

V. Phone/Fax

Practice location:
  • Phone: 844-474-4019
  • Fax:
Mailing address:
  • Phone: 330-493-4443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DOMINIC BAGNOLI
Title or Position: EXECUTIVE CHAIRMAN
Credential:
Phone: 330-493-4443