Provider Demographics
NPI:1730524257
Name:DUFF, MICHAEL SAMPSON (IDC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:SAMPSON
Last Name:DUFF
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 VICTOR WHARF ACCESS RD
Mailing Address - Street 2:BLDG 995, PEARL CITY PENINSULA
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-3400
Mailing Address - Country:US
Mailing Address - Phone:808-474-2500
Mailing Address - Fax:
Practice Address - Street 1:2001 VICTOR WHARF ACCESS RD
Practice Address - Street 2:BLDG 995, PEARL CITY PENINSULA
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-3400
Practice Address - Country:US
Practice Address - Phone:808-474-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Provider Identifiers
StateIdentifier IDID TypeIssuer
1710-1002XOtherIDC