Basic Information
| Provider Information | |||||||||
| NPI: | 1568669240 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TUBIANOSA | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 235893 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968233516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082779645 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 95-390 KUAHELANI AVE | ||||||||
| Address2: | |||||||||
| City: | MILILANI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967891192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086273200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2007 | ||||||||
| LastUpdateDate: | 02/01/2017 | ||||||||
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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 | 207Q00000X | MD 15564 | HI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.