Basic Information
| Provider Information | |||||||||
| NPI: | 1558348359 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HALOUSKA | ||||||||
| FirstName: | DON | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2180 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WAILUKU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967931625 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2180 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WAILUKU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967931625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082426464 | ||||||||
| FaxNumber: | 8082424210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2005 | ||||||||
| LastUpdateDate: | 09/09/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 19634 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 8493017 | 05 | WA | MEDICAID | 200418170A | 05 | KS | MEDICAID | 922600 | 05 | AZ | MEDICAID | 300064740 | 01 | CO | RR MCRE RIA | OTHER | 01196344 | 05 | CO | MEDICAID | 104693065 | 05 | MI | MEDICAID | 1558348359 | 05 | UT | MEDICAID | 300064090 | 01 | CO | RR MCRE MIC | OTHER | 01121668 | 05 | NY | MEDICAID | 0597948 | 05 | IA | MEDICAID | 117233600 | 05 | WY | MEDICAID | 300090374 | 01 | CO | RR MCRE DIA | OTHER | XPY204749 | 05 | CA | MEDICAID |