Provider Demographics
NPI:1902973662
Name:QUIRK, MIKE (DO)
Entity Type:Individual
Prefix:DR
First Name:MIKE
Middle Name:
Last Name:QUIRK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 S KING ST STE 906
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1953
Mailing Address - Country:US
Mailing Address - Phone:808-468-2461
Mailing Address - Fax:808-468-2461
Practice Address - Street 1:1150 S KING ST STE 906
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1953
Practice Address - Country:US
Practice Address - Phone:808-468-2461
Practice Address - Fax:808-441-1974
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7912207Q00000X
HIDOS1617207Q00000X
WAOP6005980207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH51803Medicare UPIN