Healthcare Provider Details

I. General information

NPI: 1235162959
Provider Name (Legal Business Name): BRIAN PANIK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 12/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 FARRINGTON HWY STE 201
KAPOLEI HI
96707-2028
US

IV. Provider business mailing address

PO BOX 1028
HALEIWA HI
96712-1028
US

V. Phone/Fax

Practice location:
  • Phone: 808-674-9500
  • Fax:
Mailing address:
  • Phone: 808-895-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDOS-1115
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: