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NPI Code Detail

MEDICARE: DR. SUE ELLEN OCONNOR MD

MEDICARE: DR. SUE ELLEN OCONNOR MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianL2795TX
2207RI0200XInfectious Disease PhysicianL2795TX
3207R00000XInternal Medicine Physician22267HI

General Provider Information

NPI Number : 1154309847
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUE ELLEN OCONNOR MD
Provider Business Mailing Address
First Line : 75-5751 KUAKINI HWY STE 203
Second Line :
City : KAILUA KONA
State : HI
Zip : 96740-1753
Country : US
Telephone Number : 808-326-5629
Fax Number :
Provider Business Practice Location Address
First Line : 75-5751 KUAKINI HWY STE 101A
Second Line :
City : KAILUA KONA
State : HI
Zip : 96740-1705
Country : US
Telephone Number : 808-326-5629
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2006
Last Update Date : 03/22/2023

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