Provider Demographics
NPI:1477922185
Name:HAWAII PM&R
Entity Type:Organization
Organization Name:HAWAII PM&R
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLLAROVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-931-9167
Mailing Address - Street 1:1125 YOUNG ST APT 806
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1972
Mailing Address - Country:US
Mailing Address - Phone:808-931-9167
Mailing Address - Fax:
Practice Address - Street 1:1125 YOUNG ST APT 806
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1972
Practice Address - Country:US
Practice Address - Phone:808-931-9167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI17167208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty