Provider Demographics
NPI:1871703132
Name:DUBE, AJEET (MD)
Entity type:Individual
Prefix:DR
First Name:AJEET
Middle Name:
Last Name:DUBE
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 1:770 KAPIOLANI BLVD., SUITE 705
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813
Mailing Address - Country:US
Mailing Address - Phone:808-597-8778
Mailing Address - Fax:
Practice Address - Street 1:770 KAPIOLANI BLVD., SUITE 705
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-597-8778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088354207P00000X
OH35.093095207P00000X
HI18077207P00000X
MN77115207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2978818Medicaid
IN200954210Medicaid
KY7100088210Medicaid
OH2978818Medicaid