Healthcare Provider Details

I. General information

NPI: 1912196650
Provider Name (Legal Business Name): MICHAEL ROBERT PHARAON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 10/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 S KING ST STRAUB CLINIC & HOSPITAL (PLASTIC SURGERY)
HONOLULU HI
96813-3097
US

IV. Provider business mailing address

888 S KING ST STRAUB CLINIC & HOSPITAL (PLASTIC SURGERY)
HONOLULU HI
96813-3097
US

V. Phone/Fax

Practice location:
  • Phone: 808-522-3370
  • Fax:
Mailing address:
  • Phone: 808-522-3370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD-17248
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA95642
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number180529
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: