Healthcare Provider Details

I. General information

NPI: 1063575801
Provider Name (Legal Business Name): CAROL E MINN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 FOURTH ST
PEARL CITY HI
96782-3312
US

IV. Provider business mailing address

1700 LANAKILA AVE
HONOLULU HI
96817-2115
US

V. Phone/Fax

Practice location:
  • Phone: 808-453-5953
  • Fax: 808-453-5966
Mailing address:
  • Phone: 808-832-3823
  • Fax: 808-832-5966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD-6100
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: