Provider Demographics
NPI:1376638734
Name:ADEE, ALICE C (MD)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:C
Last Name:ADEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 ULULANI STREET
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2933
Mailing Address - Country:US
Mailing Address - Phone:808-969-6664
Mailing Address - Fax:808-935-0540
Practice Address - Street 1:50 ULULANI STREET
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2933
Practice Address - Country:US
Practice Address - Phone:808-969-6664
Practice Address - Fax:808-935-0540
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI7981207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIA005965OtherHAWAII MEDICAL SERVICE AS
HI00639001Medicaid
HI00639001Medicaid