Provider Demographics
NPI:1326130618
Name:MADAN, SURESH K (MD)
Entity Type:Individual
Prefix:
First Name:SURESH
Middle Name:K
Last Name:MADAN
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 1:550 S BERETANIA ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2496
Mailing Address - Country:US
Mailing Address - Phone:808-537-2211
Mailing Address - Fax:
Practice Address - Street 1:550 S BERETANIA ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2496
Practice Address - Country:US
Practice Address - Phone:808-537-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-13618207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI019141OtherUHA
HI577819-01Medicaid
HIMD13618OtherMDX
HI0000257345OtherHMSA
HI534341OtherHMN
HIH101214Medicare PIN
HI534341OtherHMN