Provider Demographics
NPI:1467450486
Name:TETOR, LINDA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:M
Last Name:TETOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:221 PIIKEA AVE SUITE A
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753
Mailing Address - Country:US
Mailing Address - Phone:808-874-8100
Mailing Address - Fax:808-874-6887
Practice Address - Street 1:221 PIIKEA AVE SUITE A
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7313
Practice Address - Country:US
Practice Address - Phone:808-874-8100
Practice Address - Fax:808-874-6887
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2019-12-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HI18963207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COG44730Medicare UPIN