MEDICARE: DR. DAN HESLINGA 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
1	207Q00000X	Family Medicine Physician	5742	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730184300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAN HESLINGA MD

Provider Business Mailing Address
First Line	:	2386 LILOA RISE
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96822-1953
Country	:	US
Telephone Number	:	808-729-1796
Fax Number	:	555-555-5555

Provider Business Practice Location Address
First Line	:	2386 LILOA RISE
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96822
Country	:	US
Telephone Number	:	808-729-1796
Fax Number	:	808-800-2318

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	07/03/2019

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