Provider Demographics
NPI:1790875888
Name:MICKEY, JOHN V (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:V
Last Name:MICKEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:888 S KING ST
Mailing Address - Street 2:STRAUB DEPARTMENT OF INTERNAL MEDICINE
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3097
Mailing Address - Country:US
Mailing Address - Phone:808-522-4000
Mailing Address - Fax:808-522-4515
Practice Address - Street 1:888 S KING ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3009
Practice Address - Country:US
Practice Address - Phone:808-522-4000
Practice Address - Fax:808-522-4515
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2012-03-16
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Provider Licenses
StateLicense IDTaxonomies
HIMD-3556207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HID36198Medicare UPIN