Healthcare Provider Details

I. General information

NPI: 1194952457
Provider Name (Legal Business Name): MIRIAM JESSIE SEITZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MIRIAM JESSIE BENTLEY-TAYLOR M.D.

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N KING ST KALIHI-PALAMA HEALTH CENTER
HONOLULU HI
96817
US

IV. Provider business mailing address

P.O. BOX 17460 915 N KING ST
HONOLULU HI
96817
US

V. Phone/Fax

Practice location:
  • Phone: 808-845-8578
  • Fax: 808-845-7279
Mailing address:
  • Phone: 808-845-8578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number18243
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: