Provider Demographics
NPI:1366690240
Name:ALOHA FAMILY FOOTCARE LLC
Entity Type:Organization
Organization Name:ALOHA FAMILY FOOTCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:BIRCH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:808-877-3668
Mailing Address - Street 1:415 DAIRY RD
Mailing Address - Street 2:SUITE 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:SUITE D
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2312
Practice Address - Country:US
Practice Address - Phone:808-877-3668
Practice Address - Fax:808-877-3248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPO-168213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI54589001Medicaid
HIU98384Medicare UPIN
HI54589001Medicaid