Healthcare Provider Details

I. General information

NPI: 1831364843
Provider Name (Legal Business Name): TAMARA KOLLAROVA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAMARA KALOUSEK M.D.

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 N KUAKINI ST
HONOLULU HI
96817-2488
US

IV. Provider business mailing address

226 N KUAKINI ST
HONOLULU HI
96817-2488
US

V. Phone/Fax

Practice location:
  • Phone: 808-544-3362
  • Fax:
Mailing address:
  • Phone: 808-544-3362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number233634
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number17167
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number245719
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: