Provider Demographics
NPI:1598895351
Name:GRATZ, ADAM JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:JOSEPH
Last Name:GRATZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 820
Mailing Address - Street 2:
Mailing Address - City:KAPAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96755-0820
Mailing Address - Country:US
Mailing Address - Phone:808-854-1684
Mailing Address - Fax:
Practice Address - Street 1:55-515 HAWI RD
Practice Address - Street 2:
Practice Address - City:HAWI
Practice Address - State:HI
Practice Address - Zip Code:96719-9997
Practice Address - Country:US
Practice Address - Phone:808-960-3311
Practice Address - Fax:866-263-1889
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS-1090208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIE07702OtherCERTIFICATE OF REGISTRATION FOR CONTROLLED SUBSTANCES
HIE07702OtherCERTIFICATE OF REGISTRATION FOR CONTROLLED SUBSTANCES
HI149513Medicare UPIN
HIBG9495804OtherDEA NUMBER