Provider Demographics
NPI:1316043334
Name:WHITESIDE, TIMOTHY F (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:F
Last Name:WHITESIDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 ULUNIU ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2519
Mailing Address - Country:US
Mailing Address - Phone:808-561-0764
Mailing Address - Fax:808-263-4604
Practice Address - Street 1:407 ULUNIU ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2519
Practice Address - Country:US
Practice Address - Phone:808-261-3326
Practice Address - Fax:808-263-4604
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD - 10740207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000217067OtherHMSA
HI251360Medicaid
HIH51921Medicare ID - Type Unspecified
HIF23888Medicare UPIN