Healthcare Provider Details

I. General information

NPI: 1427038561
Provider Name (Legal Business Name): NORMAN T IKEMOTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 ULUKAHIKI ST
KAILUA HI
96734
US

IV. Provider business mailing address

941 KAMEHAMEHA HWY STE 208
PEARL CITY HI
96782-2516
US

V. Phone/Fax

Practice location:
  • Phone: 808-263-5166
  • Fax: 808-263-5167
Mailing address:
  • Phone: 808-454-5200
  • Fax: 808-454-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2815
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: