Healthcare Provider Details

I. General information

NPI: 1982891297
Provider Name (Legal Business Name): MISAKO MCLEOD DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 08/14/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 WAIANUENUE AVENUE
HILO HI
96720
US

IV. Provider business mailing address

67-1249 KOALIULA PL
KAMUELA HI
96743-8463
US

V. Phone/Fax

Practice location:
  • Phone: 808-961-3668
  • Fax:
Mailing address:
  • Phone: 415-302-0239
  • Fax: 844-412-6553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4736
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1107
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO-215
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: