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General NPI Number Information
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NPI Number | 1760246458
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Entity Type | Organization
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Legal Business Name | THE M CLINIC LLC
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Dates
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Enumeration Date | 02/12/2024
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 55 S KUKUI ST STE C108
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City | HONOLULU
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State | HI
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Zip | 96813-2328
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Country | US
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Telephone | 808-727-1081
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Fax | 612-421-0028
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Provider Business Mailing Address
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Address Line | 55 S KUKUI ST STE C108
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City | HONOLULU
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State | HI
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Zip | 96813-2328
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Country | US
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Telephone | 808-727-1081
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Fax | 612-421-0028
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Authorized Official
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Title or Position | OWNER
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Name | MINDY L MANDICH
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Credential | DO
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Telephone | 808-342-6606
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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 |
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License Number State |
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