Provider Demographics
NPI:1962275784
Name:ISLAND SURGICAL SPECIALISTS, LLC
Entity type:Organization
Organization Name:ISLAND SURGICAL SPECIALISTS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KRISHNA
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-457-4057
Mailing Address - Street 1:405 N KUAKINI ST STE 1001
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-6301
Mailing Address - Country:US
Mailing Address - Phone:808-457-4057
Mailing Address - Fax:866-591-8027
Practice Address - Street 1:405 N KUAKINI ST STE 1001
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-6301
Practice Address - Country:US
Practice Address - Phone:808-457-4057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-02
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty