Provider Demographics
NPI:1447545330
Name:GROSJEAN, EVAN M (MD)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:M
Last Name:GROSJEAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 ALA WAI BLVD
Mailing Address - Street 2:APT 1503
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-3981
Mailing Address - Country:US
Mailing Address - Phone:412-610-5990
Mailing Address - Fax:
Practice Address - Street 1:770 KAPIOLANI BLVD
Practice Address - Street 2:SUITE 705
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5212
Practice Address - Country:US
Practice Address - Phone:412-610-5990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT199732207P00000X
PAMD450220207P00000X
HI18083207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine