Provider Demographics
NPI:1225207830
Name:BIG ISLAND FOOT CARE, INC
Entity Type:Organization
Organization Name:BIG ISLAND FOOT CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:SUGAI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:808-935-5597
Mailing Address - Street 1:101 AUPUNI ST STE 238
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4261
Mailing Address - Country:US
Mailing Address - Phone:808-935-5597
Mailing Address - Fax:808-935-7904
Practice Address - Street 1:101 AUPUNI ST
Practice Address - Street 2:STE 238
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4261
Practice Address - Country:US
Practice Address - Phone:808-935-5597
Practice Address - Fax:808-935-7904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPO 118213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI03103001Medicaid
HI03103001Medicaid
HI0541010001Medicare NSC
HIHBIFMedicare PIN