Provider Demographics
NPI:1154710838
Name:ILONA L. HIGGINS MD, LLC
Entity type:Organization
Organization Name:ILONA L. HIGGINS MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ILONA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-895-9486
Mailing Address - Street 1:PO BOX 6805
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-6805
Mailing Address - Country:US
Mailing Address - Phone:808-895-9486
Mailing Address - Fax:
Practice Address - Street 1:65-1298B KAWAIHAE RD
Practice Address - Street 2:SUITE #1
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-7342
Practice Address - Country:US
Practice Address - Phone:808-930-6550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-17
Last Update Date:2015-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD5037207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty