1174544878 NPI number — DR. HAROLD DAN BERTIL NILSSON M.D.

Table of content: DR. HAROLD DAN BERTIL NILSSON M.D. (NPI 1174544878)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174544878 NPI number — DR. HAROLD DAN BERTIL NILSSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NILSSON
Provider First Name:
HAROLD
Provider Middle Name:
DAN BERTIL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NILSSON
Provider Other First Name:
HARALD
Provider Other Middle Name:
DAN BERTIL
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174544878
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1441 KAPIOLANI BLVD
Provider Second Line Business Mailing Address:
SUITE 825
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96814-4402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-941-2772
Provider Business Mailing Address Fax Number:
808-947-4150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1441 KAPIOLANI BLVD
Provider Second Line Business Practice Location Address:
SUITE 825
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96814-4402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-941-2772
Provider Business Practice Location Address Fax Number:
808-947-4150
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  MD7520 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02787301 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: C3118-1 . This is a "HMSA PPO/HPH" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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