Provider Demographics
NPI:1992940720
Name:GOTTNER, MICHAEL JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:GOTTNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1620 ALA MOANA BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-1437
Mailing Address - Country:US
Mailing Address - Phone:808-955-0255
Mailing Address - Fax:
Practice Address - Street 1:1620 ALA MOANA BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-1437
Practice Address - Country:US
Practice Address - Phone:808-955-0255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 11277207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology