Provider Demographics
NPI:1962804567
Name:GRAHAM M CORMACK, MD, LLC
Entity type:Organization
Organization Name:GRAHAM M CORMACK, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GRAHAM
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CORMACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-343-2769
Mailing Address - Street 1:PO BOX 26418
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825
Mailing Address - Country:US
Mailing Address - Phone:808-343-2769
Mailing Address - Fax:866-594-4786
Practice Address - Street 1:1301 PUNCHBOWL ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-343-2769
Practice Address - Fax:866-594-4786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD13938207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty