Healthcare Provider Details

I. General information

NPI: 1922622588
Provider Name (Legal Business Name): ISLAND FOOT AND ANKLE SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 DAIRY RD STE D
KAHULUI HI
96732-2348
US

IV. Provider business mailing address

415 DAIRY RD STE D
KAHULUI HI
96732-2348
US

V. Phone/Fax

Practice location:
  • Phone: 808-877-3668
  • Fax: 808-877-3248
Mailing address:
  • Phone: 808-877-3668
  • Fax: 808-877-3248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS K BIRCH
Title or Position: PHYSICIAN
Credential: DPM
Phone: 808-877-3668