Provider Demographics
NPI:1174544878
Name:NILSSON, HAROLD DAN BERTIL (MD)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:DAN BERTIL
Last Name:NILSSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HARALD
Other - Middle Name:DAN BERTIL
Other - Last Name:NILSSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1441 KAPIOLANI BLVD
Mailing Address - Street 2:SUITE 825
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4402
Mailing Address - Country:US
Mailing Address - Phone:808-941-2772
Mailing Address - Fax:808-947-4150
Practice Address - Street 1:1441 KAPIOLANI BLVD
Practice Address - Street 2:SUITE 825
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4402
Practice Address - Country:US
Practice Address - Phone:808-941-2772
Practice Address - Fax:808-947-4150
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD7520208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02787301Medicaid
HIC3118-1OtherHMSA PPO/HPH
HIG68161Medicare UPIN
HI51020Medicare ID - Type Unspecified