Provider Demographics
NPI:1760566913
Name:MICKELS, ELLEN K (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:K
Last Name:MICKELS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELLEN
Other - Middle Name:K
Other - Last Name:PERZINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:46-056 KAMEHAMEHA HWY
Mailing Address - Street 2:SUITE 221
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3755
Mailing Address - Country:US
Mailing Address - Phone:808-233-6200
Mailing Address - Fax:808-233-6255
Practice Address - Street 1:46-056 KAMEHAMEHA HWY
Practice Address - Street 2:SUITE 221
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3755
Practice Address - Country:US
Practice Address - Phone:808-233-6200
Practice Address - Fax:808-233-6255
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-13156207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000253914OtherHMSA
HI9158444OtherUHA
HI569618 01Medicaid
HIA96055Medicare UPIN
HI0000253914OtherHMSA