Healthcare Provider Details

I. General information

NPI: 1962275784
Provider Name (Legal Business Name): ISLAND SURGICAL SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 N KUAKINI ST STE 1001
HONOLULU HI
96817-6301
US

IV. Provider business mailing address

405 N KUAKINI ST STE 1001
HONOLULU HI
96817-6301
US

V. Phone/Fax

Practice location:
  • Phone: 808-457-4057
  • Fax:
Mailing address:
  • Phone: 808-457-4057
  • Fax: 866-591-8027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL KRISHNA RAO
Title or Position: MEMBER
Credential: MD
Phone: 808-457-4057