Healthcare Provider Details

I. General information

NPI: 1215145057
Provider Name (Legal Business Name): MICHAEL LAWRENCE RIMM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 MAKAWAO AVE SUITE 106
MAKAWAO HI
96768-9465
US

IV. Provider business mailing address

324 LILIUOKALANI ST
MAKAWAO HI
96768-8633
US

V. Phone/Fax

Practice location:
  • Phone: 808-268-2805
  • Fax: 808-572-4500
Mailing address:
  • Phone: 808-268-2805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD12243
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD12243
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: