Healthcare Provider Details

I. General information

NPI: 1265514830
Provider Name (Legal Business Name): IVAN PREIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 KAIULANI AVE LOBBY LEVEL
HONOLULU HI
96815-3227
US

IV. Provider business mailing address

120 KAIULANI AVE STRAUB DOCS ON CALL LOBBY LEVEL
HONOLULU HI
96815-6203
US

V. Phone/Fax

Practice location:
  • Phone: 808-971-6000
  • Fax: 808-971-6042
Mailing address:
  • Phone: 808-971-6000
  • Fax: 808-971-6042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberMD-5187
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: