Provider Demographics
NPI:1255312401
Name:TOMITA, NATHAN P (DO)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:P
Last Name:TOMITA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99-115 AIEA HEIGHTS DR STE 276B
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-3924
Mailing Address - Country:US
Mailing Address - Phone:808-784-3050
Mailing Address - Fax:808-784-3059
Practice Address - Street 1:99-115 AIEA HEIGHTS DR STE 276B
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3924
Practice Address - Country:US
Practice Address - Phone:808-784-3050
Practice Address - Fax:808-784-3059
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013860208600000X
HIDOS1441208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114583911Medicaid
MI0257801385OtherBCBSM
MI114583911Medicaid
MION90020Medicare ID - Type Unspecified