Provider Demographics
NPI:1033113071
Name:BIRCH, DOUGLAS K (DPM)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:K
Last Name:BIRCH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 DAIRY RD
Mailing Address - Street 2:STE D
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2348
Mailing Address - Country:US
Mailing Address - Phone:808-877-3668
Mailing Address - Fax:808-877-3248
Practice Address - Street 1:415 DAIRY RD
Practice Address - Street 2:STE D
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2348
Practice Address - Country:US
Practice Address - Phone:808-877-3668
Practice Address - Fax:808-877-3248
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPO-168213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI54589001Medicaid
HIH56148Medicare PIN
HI5193960001Medicare NSC
HIU98384Medicare UPIN