Individual
ANDREW THOMAS WIDHOLM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1360 S BERETANIA ST, #215, HONOLULU, HI 96814-1520
(808) 532-3711
(808) 532-3713
Mailing address
415 DAIRY RD, SUITE E233, KAHULUI, HI 96732-2348
(808) 298-1802
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
DOS788
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002726-01
ACS
—
01
—
00A0213387
HMSA
—
01
—
A020
CHAMPUS TRICARE
—
Enumeration date
06/22/2006
Last updated
01/29/2009
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