MEDICARE: SUSAN DRELICH

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
1	207L00000X	Anesthesiology Physician	MD11125	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	A022	OTHER	CHAMPUS TRICARE
2	0000225094	OTHER	HMSA
3	494732-01	OTHER	ACS

General Provider Information

NPI Number	:	1558306837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN DRELICH

Provider Business Mailing Address
First Line	:	2486 WAIPUA ST
Second Line	:
City	:	PAIA
State	:	HI
Zip	:	96779-9748
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1360 S BERETANIA ST
Second Line	:	#215
City	:	HONOLULU
State	:	HI
Zip	:	96814-1520
Country	:	US
Telephone Number	:	808-532-3711
Fax Number	:	808-532-3713

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	07/08/2007

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Directions to “ SUSAN DRELICH ” Practice Location

Language	Start Address	Practice Location

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