Provider Demographics
NPI:1558348359
Name:HALOUSKA, DON L (MD)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:L
Last Name:HALOUSKA
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 1:2180 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1625
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2180 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1625
Practice Address - Country:US
Practice Address - Phone:808-242-6464
Practice Address - Fax:808-242-4210
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO196342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8493017Medicaid
KS200418170AMedicaid
AZ922600Medicaid
CO300064740OtherRR MCRE RIA
CO01196344Medicaid
MI104693065Medicaid
UT1558348359Medicaid
CO300064090OtherRR MCRE MIC
NY01121668Medicaid
IA0597948Medicaid
WY117233600Medicaid
CO300090374OtherRR MCRE DIA
CAXPY204749Medicaid
CAXPY204749Medicaid
MI104693065Medicaid
COC22484Medicare PIN
COCW5118Medicare PIN
KS130698Medicare PIN