Provider Demographics
NPI:1023144714
Name:WAIKIKI FAMILY PRACTICE PHYSICIANS LLC
Entity type:Organization
Organization Name:WAIKIKI FAMILY PRACTICE PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:DUKELOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-922-6000
Mailing Address - Street 1:2424 KALAKAUA AVENUE
Mailing Address - Street 2:SUITE 476A
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-3233
Mailing Address - Country:US
Mailing Address - Phone:808-922-6000
Mailing Address - Fax:808-922-2680
Practice Address - Street 1:2424 KALAKAUA AVENUE
Practice Address - Street 2:SUITE 476A
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-3233
Practice Address - Country:US
Practice Address - Phone:808-922-6000
Practice Address - Fax:808-922-2680
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAIKIKI FAMILY PRACTICE PHYSICIANS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-26
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD13296207Q00000X
HIMD13253207R00000X
HI13296207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI=========OtherTAX ID