Provider Demographics
NPI:1518902295
Name:LIMPISVASTI, PANU (MD)
Entity Type:Individual
Prefix:MR
First Name:PANU
Middle Name:
Last Name:LIMPISVASTI
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 1:1520 LILIHA STREET
Mailing Address - Street 2:#701
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817
Mailing Address - Country:US
Mailing Address - Phone:808-528-4577
Mailing Address - Fax:808-528-4577
Practice Address - Street 1:1520 LILIHA STREET
Practice Address - Street 2:#701
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817
Practice Address - Country:US
Practice Address - Phone:808-528-4577
Practice Address - Fax:808-528-4577
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD2476207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00A0037810OtherHMSA
HIHOtherMEDICARE ID-PIN
HI03424201Medicaid
HI2476OtherMDX QUEENS
HIHOtherMEDICARE ID-PIN
HIHMedicare PIN
HI03424201Medicaid