Basic Information
| Provider Information | |||||||||
| NPI: | 1033280615 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHIGEMURA | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 46-056 KAMEHAMEHA HWY | ||||||||
| Address2: | SUITE 221 | ||||||||
| City: | KANEOHE | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967443755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082336200 | ||||||||
| FaxNumber: | 8082336255 | ||||||||
| Practice Location | |||||||||
| Address1: | 46-056 KAMEHAMEHA HWY | ||||||||
| Address2: | SUITE 221 | ||||||||
| City: | KANEOHE | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967443755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082336200 | ||||||||
| FaxNumber: | 8082336255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2006 | ||||||||
| LastUpdateDate: | 09/23/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD-6548 | HI | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 059905 | 05 | HI | MEDICAID | 0000079558 | 01 | HI | HMSA | OTHER | 1500444 | 01 | HI | UHA | OTHER |