Provider Demographics
NPI:1972660140
Name:SENFT, SUSAN HEIDI (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:HEIDI
Last Name:SENFT
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 1:75-1028 HENRY ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1693
Mailing Address - Country:US
Mailing Address - Phone:808-329-3937
Mailing Address - Fax:808-329-0633
Practice Address - Street 1:75-1028 HENRY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1693
Practice Address - Country:US
Practice Address - Phone:808-329-3937
Practice Address - Fax:808-329-0633
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-8824207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI040732-01Medicaid
HI040732-01Medicaid
HIH101225Medicare ID - Type Unspecified