Healthcare Provider Details

I. General information

NPI: 1043413040
Provider Name (Legal Business Name): MARK T. GRATTAN, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 S KING ST
HONOLULU HI
96813-3009
US

IV. Provider business mailing address

820 MILILANI ST SUITE 702A
HONOLULU HI
96813-2924
US

V. Phone/Fax

Practice location:
  • Phone: 808-522-3068
  • Fax:
Mailing address:
  • Phone: 808-523-9363
  • Fax: 808-523-9418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD 7469
License Number StateHI

VIII. Authorized Official

Name: DR. MARK T. GRATTAN
Title or Position: SOLE PROPRIETOR
Credential: M.D.
Phone: 808-522-3068