Provider Demographics
NPI:1861449951
Name:ISADORE, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:ISADORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5333 LIKINI ST
Mailing Address - Street 2:#1201
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-1762
Mailing Address - Country:US
Mailing Address - Phone:808-594-7845
Mailing Address - Fax:808-594-7845
Practice Address - Street 1:5333 LIKINI ST
Practice Address - Street 2:#1201
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-1762
Practice Address - Country:US
Practice Address - Phone:808-594-7845
Practice Address - Fax:808-594-7845
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD10229207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI088472Medicaid
HI088472Medicaid
G73184Medicare UPIN