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Individual

STEPHEN SUSSMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2180 MAIN ST, WAILUKU, HI 96793-1666
(808) 242-6464
(808) 948-7438
Mailing address
2180 MAIN ST, WAILUKU, HI 96793-1666
(808) 242-6464
(808) 948-7438

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
MD11619
HI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
238378
HMSA, HMSA QUEST, 65CP
HI
01
515743
UHA
HI
01
99017685996793B094
TRICARE CHAMPUS
HI
Enumeration date
08/12/2006
Last updated
09/09/2010
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