Provider Demographics
NPI:1255566816
Name:DYKEMA, MATTHEW S (DO)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:S
Last Name:DYKEMA
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1248 KINOOLE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4171
Mailing Address - Country:US
Mailing Address - Phone:808-935-8398
Mailing Address - Fax:808-934-8151
Practice Address - Street 1:1248 KINOOLE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4171
Practice Address - Country:US
Practice Address - Phone:808-935-8398
Practice Address - Fax:808-934-8151
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2019-02-08
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Provider Licenses
StateLicense IDTaxonomies
HIDOS-1454207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1255566816Medicaid