Healthcare Provider Details

I. General information

NPI: 1891716072
Provider Name (Legal Business Name): CHRISTOPHER ANDREW FIACK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 05/27/2020
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 LUSITANA ST STE 107
HONOLULU HI
96813-2401
US

IV. Provider business mailing address

1329 LUSITANA ST STE 107
HONOLULU HI
96813-2401
US

V. Phone/Fax

Practice location:
  • Phone: 808-691-5252
  • Fax: 808-691-5250
Mailing address:
  • Phone: 808-691-5252
  • Fax: 808-691-5250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD14711
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD14711
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD14711
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: