Provider Demographics
NPI:1982891297
Name:MCLEOD, MISAKO (DPM)
Entity Type:Individual
Prefix:DR
First Name:MISAKO
Middle Name:
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 KINOOLE ST STE 104
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3800
Mailing Address - Country:US
Mailing Address - Phone:844-442-3668
Mailing Address - Fax:844-412-6553
Practice Address - Street 1:1028 KINOOLE ST STE 104
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720
Practice Address - Country:US
Practice Address - Phone:444-423-6688
Practice Address - Fax:844-442-3668
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2018-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4736213ES0103X
NV1107213ES0103X
HIPO-215213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH108090OtherMEDICARE PTAN