Provider Demographics
NPI:1780629543
Name:SVOBODA, ALICE C (MD)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:C
Last Name:SVOBODA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KEOKEA PL
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790-7450
Mailing Address - Country:US
Mailing Address - Phone:808-876-4341
Mailing Address - Fax:808-878-1791
Practice Address - Street 1:100 KEOKEA PL
Practice Address - Street 2:
Practice Address - City:KULA
Practice Address - State:HI
Practice Address - Zip Code:96790-7450
Practice Address - Country:US
Practice Address - Phone:808-876-4331
Practice Address - Fax:808-876-4332
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS30953207Q00000X
HI16883207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I30721Medicare UPIN
I30721Medicare UPIN
KS104732OtherBCBS
KS12313988OtherMULTIPLAN
KS104732Medicare ID - Type Unspecified
KS107897OtherHPK
KS8998OtherPHS