Provider Demographics
NPI:1033280615
Name:SHIGEMURA, LISA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:SHIGEMURA
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 1:46-056 KAMEHAMEHA HWY
Mailing Address - Street 2:SUITE 221
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3755
Mailing Address - Country:US
Mailing Address - Phone:808-233-6200
Mailing Address - Fax:808-233-6255
Practice Address - Street 1:46-056 KAMEHAMEHA HWY
Practice Address - Street 2:SUITE 221
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3755
Practice Address - Country:US
Practice Address - Phone:808-233-6200
Practice Address - Fax:808-233-6255
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-6548208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI059905Medicaid
HI0000079558OtherHMSA
HI1500444OtherUHA
HI1500444OtherUHA
HI0000079558OtherHMSA