Basic Information
| Provider Information | |||||||||
| NPI: | 1770719098 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VOULGARIDIS | ||||||||
| FirstName: | MARIOS | ||||||||
| MiddleName: | GEORGIOS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 671 OLD MOKAPU RD | ||||||||
| Address2: | |||||||||
| City: | KAILUA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967341636 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 347 N KUAKINI ST | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968172336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085238461 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2009 | ||||||||
| LastUpdateDate: | 06/01/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 15099 | HI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.