Provider Demographics
NPI:1740641513
Name:HAWAII FOOT AND ANKLE SURGICAL SPECIALISTS, LLC
Entity type:Organization
Organization Name:HAWAII FOOT AND ANKLE SURGICAL SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MISAKO
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:415-302-0239
Mailing Address - Street 1:1028 KINOOLE ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3800
Mailing Address - Country:US
Mailing Address - Phone:808-935-3121
Mailing Address - Fax:808-443-0400
Practice Address - Street 1:1028 KINOOLE ST
Practice Address - Street 2:SUITE 104
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3800
Practice Address - Country:US
Practice Address - Phone:808-935-3121
Practice Address - Fax:808-443-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty