Provider Demographics
NPI:1316099963
Name:HELLREICH, PHILIP DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:DAVID
Last Name:HELLREICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 AULIKE ST
Mailing Address - Street 2:SUITE 311
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2758
Mailing Address - Country:US
Mailing Address - Phone:808-261-6133
Mailing Address - Fax:808-262-9222
Practice Address - Street 1:40 AULIKE ST
Practice Address - Street 2:SUITE 311
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2758
Practice Address - Country:US
Practice Address - Phone:808-261-6133
Practice Address - Fax:808-262-9222
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2088207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIA3463 5OtherHSMA KANEOHE
HIMD2088 02OtherQHCP MDX
HI03119501Medicaid
HIX3463 2OtherHMSA
HIMD2088OtherQHCP MDX
HI191661OtherHIEL
HIC98454Medicare UPIN
HI0000BDBKV KDAMedicare ID - Type UnspecifiedMEDICARE