Provider Demographics
NPI:1063568657
Name:CARLSEN, SOREN N (MD)
Entity type:Individual
Prefix:
First Name:SOREN
Middle Name:N
Last Name:CARLSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 KANOA ST STE 201
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-5816
Mailing Address - Country:US
Mailing Address - Phone:808-242-8765
Mailing Address - Fax:808-242-8769
Practice Address - Street 1:71 KANOA ST STE 201
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-5816
Practice Address - Country:US
Practice Address - Phone:808-242-8765
Practice Address - Fax:808-242-8769
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD60107187208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology