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General NPI Number Information
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NPI Number | 1558764662
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Entity Type | Organization
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Legal Business Name | ISLAND PODIATRY, LLC
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Dates
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Enumeration Date | 10/02/2014
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Last Update Date | 02/11/2015
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Provider Practice Location Address
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Address Line | 99 S MARKET ST SUITE 104
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City | WAILUKU
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State | HI
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Zip | 96793-2200
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Country | US
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Telephone | 808-243-5464
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Fax | 808-243-5465
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Provider Business Mailing Address
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Address Line | 99 S MARKET ST SUITE 104
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City | WAILUKU
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State | HI
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Zip | 96793-2200
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Country | US
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Telephone | 808-243-5464
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Fax | 808-243-5465
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | STEVEN A KING
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Credential | DPM
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Telephone | 808-243-5465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO-137
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License Number State | HI
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