Provider Demographics
NPI:1720173214
Name:HANSEN, TILL PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:TILL
Middle Name:PETER
Last Name:HANSEN
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 1:415 DAIRY ROAD
Mailing Address - Street 2:SUITE E-438
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2348
Mailing Address - Country:US
Mailing Address - Phone:808-242-5856
Mailing Address - Fax:808-242-5949
Practice Address - Street 1:24 N CHURCH ST
Practice Address - Street 2:SUITE 403
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1680
Practice Address - Country:US
Practice Address - Phone:808-242-5856
Practice Address - Fax:808-242-5856
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI6493207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
F11520Medicare UPIN
HIH56504Medicare PIN