=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760894984
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMERGENCY MEDICINE PHYSICIANS OF HONOLULU KAPIOLANI, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2014
-----------------------------------------------------
Last Update Date | 06/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1319 PUNAHOU ST
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96826-1001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-474-4019
-----------------------------------------------------
Fax | 330-493-8677
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4535 DRESSLER RD NW
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44718-2545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-493-4443
-----------------------------------------------------
Fax | 330-493-8677
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE CHAIRMAN
-----------------------------------------------------
Name | DOMINIC BAGNOLI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-493-4443
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------