Healthcare Provider Details

I. General information

NPI: 1164489555
Provider Name (Legal Business Name): MICHAEL JT SEU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 06/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 PONAHAWAI ST #110
HILO HI
96720
US

IV. Provider business mailing address

688 KINOOLE ST STE 103
HILO HI
96720
US

V. Phone/Fax

Practice location:
  • Phone: 808-933-2540
  • Fax: 808-935-5207
Mailing address:
  • Phone: 808-935-1825
  • Fax: 808-935-5362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberMD5534
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD5534
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD5534
License Number StateHI
# 4
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberMD5534
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: