Provider Demographics
NPI:1639242829
Name:KUROSAWA, MICHAEL N (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:N
Last Name:KUROSAWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-151 PALI MOMI ST
Mailing Address - Street 2:SUITE 142
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4300
Mailing Address - Country:US
Mailing Address - Phone:808-483-6400
Mailing Address - Fax:808-483-6487
Practice Address - Street 1:98-151 PALI MOMI ST
Practice Address - Street 2:SUITE 142
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4300
Practice Address - Country:US
Practice Address - Phone:808-483-6400
Practice Address - Fax:808-483-6487
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-7865207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000095273OtherHMSA
HI073314Medicaid
HI3214444OtherUHA
HI53905Medicare ID - Type Unspecified
HIF11641Medicare UPIN