Provider Demographics
NPI:1881701076
Name:CAULEY, SUSAN MARGARET (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARGARET
Last Name:CAULEY
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 1:1029 AINAKO AVE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-1503
Mailing Address - Country:US
Mailing Address - Phone:808-933-1384
Mailing Address - Fax:
Practice Address - Street 1:82 PUUHONU PL
Practice Address - Street 2:SUITE 202
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2010
Practice Address - Country:US
Practice Address - Phone:808-969-9966
Practice Address - Fax:877-833-8003
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 8551207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI070982-04Medicaid
F72971Medicare UPIN