Healthcare Provider Details

I. General information

NPI: 1174805188
Provider Name (Legal Business Name): MICHAEL WINKLE INDEPENDENT DUTY COR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3D MARINE REGIMENT (-) (REIN) (RAS) BOX 63005 MCBH
KANEOHE BAY HI
96863
US

IV. Provider business mailing address

3D MARINE REGIMENT (-) (REIN) BOX 63005 MCBH
FPO AP
96863
US

V. Phone/Fax

Practice location:
  • Phone: 808-722-8398
  • Fax:
Mailing address:
  • Phone: 808-722-8398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: