Provider Demographics
NPI:1699870956
Name:ENDO, PATTI KM (MD)
Entity type:Individual
Prefix:
First Name:PATTI
Middle Name:KM
Last Name:ENDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 WELLS ST
Mailing Address - Street 2:STE 102
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2365
Mailing Address - Country:US
Mailing Address - Phone:808-877-3635
Mailing Address - Fax:808-877-4363
Practice Address - Street 1:1830 WELLS ST 102
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2365
Practice Address - Country:US
Practice Address - Phone:808-877-3635
Practice Address - Fax:808-877-4363
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 9088207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI07506301Medicaid
HIB202107OtherBCBS
HI07506301Medicaid
HIH0000BDXQJMedicare ID - Type Unspecified