Healthcare Provider Details

I. General information

NPI: 1932506797
Provider Name (Legal Business Name): NORMAN MICHAEL TRUDELL MLT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MICHAEL TRUDELL MLT

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 11/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 PIIKOI ST APT 22A
HONOLULU HI
96814-1838
US

IV. Provider business mailing address

1111 PIIKOI ST APT 22A
HONOLULU HI
96814-1838
US

V. Phone/Fax

Practice location:
  • Phone: 918-290-9675
  • Fax:
Mailing address:
  • Phone: 918-290-9675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number5301
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: