Healthcare Provider Details

I. General information

NPI: 1184680605
Provider Name (Legal Business Name): MARK A. PITHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65-1267 KAWAIHAE RD
KAMUELA HI
96743-7345
US

IV. Provider business mailing address

4700 E 56TH ST STE 100
DAVENPORT IA
52807-2904
US

V. Phone/Fax

Practice location:
  • Phone: 808-881-4745
  • Fax:
Mailing address:
  • Phone: 563-421-0480
  • Fax: 563-421-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD-44690
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD23591
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: