Organization
ISLAND CARDIOVASCULAR & VEIN INSTITUTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMISON WYATT MD (PRESIDENT PHYSICIAN)
(210) 218-3328
Entity
Organization
Contact information
Practice address
75-5591 PALANI RD STE 2002, KAILUA KONA, HI 96740-3634
(210) 218-3328
Mailing address
75-5591 PALANI RD STE 2002, KAILUA KONA, HI 96740-3634
(210) 218-3328
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD-20303
HAWAII MEDICAL LICENSE
HI
Enumeration date
09/03/2021
Last updated
02/07/2022
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