Provider Demographics
NPI:1447289194
Name:LETTICH, LOUISE M (MD)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:M
Last Name:LETTICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 KAILUA RD APT 8208
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2965
Mailing Address - Country:US
Mailing Address - Phone:808-429-2581
Mailing Address - Fax:
Practice Address - Street 1:755 SCOTT CIR
Practice Address - Street 2:
Practice Address - City:JBPHH
Practice Address - State:HI
Practice Address - Zip Code:96853-5399
Practice Address - Country:US
Practice Address - Phone:808-448-6377
Practice Address - Fax:866-269-3450
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA517792084P0800X
HIMD85792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI07946301Medicaid
HI00E0208735OtherHAWAII MEDICAL SVC ASSN
HI50013Medicare ID - Type Unspecified