Organization
AIEA MEDICAL GROUP,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL JOHN DIMITRION M.D. (PRESIDENT)
(808) 488-7770
Entity
Organization
Contact information
Practice address
98-1079 MOANALUA RD, SUITE 420, AIEA, HI 96701-4713
(808) 488-7770
Mailing address
98-1079 MOANALUA RD, SUITE 420, AIEA, HI 96701-4713
(808) 488-7770
(808) 487-0104
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
3107
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03759701
—
HI
Enumeration date
11/19/2012
Last updated
11/19/2012
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