Healthcare Provider Details

I. General information

NPI: 1881701076
Provider Name (Legal Business Name): SUSAN MARGARET CAULEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 PUUHONU PL SUITE 202
HILO HI
96720-2010
US

IV. Provider business mailing address

1029 AINAKO AVE
HILO HI
96720-1503
US

V. Phone/Fax

Practice location:
  • Phone: 808-969-9966
  • Fax: 877-833-8003
Mailing address:
  • Phone: 808-933-1384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD 8551
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: