Basic Information
| Provider Information | |||||||||
| NPI: | 1427491851 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAUI LANI PHYSICIANS AND SURGEONS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 165 MAA ST | ||||||||
| Address2: | |||||||||
| City: | KAHULUI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967323603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084467120 | ||||||||
| FaxNumber: | 8084467121 | ||||||||
| Practice Location | |||||||||
| Address1: | 165 MAA ST | ||||||||
| Address2: | |||||||||
| City: | KAHULUI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967323603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084467120 | ||||||||
| FaxNumber: | 8084467121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2013 | ||||||||
| LastUpdateDate: | 05/31/2013 | ||||||||
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| AuthorizedOfficialLastName: | TAKEMOTO | ||||||||
| AuthorizedOfficialFirstName: | CHRISTY | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8083853941 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | DOS 1403 | HI | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 208600000X | MD 6373 | HI | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | 207V00000X | MD 14156 | HI | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.