Provider Demographics
NPI:1912053885
Name:PETROVITCH, HELEN (MD)
Entity Type:Individual
Prefix:DR
First Name:HELEN
Middle Name:
Last Name:PETROVITCH
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 1:846 S HOTEL ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2583
Mailing Address - Country:US
Mailing Address - Phone:808-564-5420
Mailing Address - Fax:808-524-4315
Practice Address - Street 1:846 S HOTEL ST
Practice Address - Street 2:SUITE 307
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2583
Practice Address - Country:US
Practice Address - Phone:808-564-5420
Practice Address - Fax:808-524-4315
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4651207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI58511Medicare UPIN