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General NPI Number Information
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NPI Number | 1073796868
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Entity Type | Organization
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Legal Business Name | SCOTT J. MISCOVICH MD, LLC
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Dates
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Enumeration Date | 12/14/2007
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 46-001 KAMEHAMEHA HWY STE 109
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City | KANEOHE
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State | HI
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Zip | 96744-3724
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Country | US
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Telephone | 808-247-7596
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Fax |
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Provider Business Mailing Address
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Address Line | 46-001 KAMEHAMEHA HWY STE 109
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City | KANEOHE
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State | HI
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Zip | 96744-3724
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Country | US
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Telephone | 808-247-7596
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT
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Name | RENE NOELLE MANSANAS
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Credential |
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Telephone | 808-379-1515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD6854
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License Number State | HI
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