Provider Demographics
NPI:1760246458
Name:THE M CLINIC LLC
Entity Type:Organization
Organization Name:THE M CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MANDICH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:808-342-6606
Mailing Address - Street 1:55 S KUKUI ST STE C108
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2328
Mailing Address - Country:US
Mailing Address - Phone:808-727-1081
Mailing Address - Fax:612-421-0028
Practice Address - Street 1:55 S KUKUI ST STE C108
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2328
Practice Address - Country:US
Practice Address - Phone:808-727-1081
Practice Address - Fax:612-421-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty