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General NPI Number Information
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NPI Number | 1447545330
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Entity Type | Individual
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Provider Name | EVAN M GROSJEAN MD
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Gender | Male
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Dates
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Enumeration Date | 06/20/2011
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Last Update Date | 11/11/2015
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Provider Practice Location Address
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Address Line | 770 KAPIOLANI BLVD SUITE 705
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City | HONOLULU
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State | HI
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Zip | 96813-5212
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Country | US
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Telephone | 412-610-5990
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Fax |
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Provider Business Mailing Address
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Address Line | 2611 ALA WAI BLVD APT 1503
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City | HONOLULU
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State | HI
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Zip | 96815-3981
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Country | US
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Telephone | 412-610-5990
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MT199732
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD450220
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 18083
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License Number State | HI
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