Provider Demographics
NPI:1073761227
Name:STUART L. RUSNAK, M.D., INC.
Entity Type:Organization
Organization Name:STUART L. RUSNAK, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUSNAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-955-0788
Mailing Address - Street 1:1319 PUNAHOU ST
Mailing Address - Street 2:SUITE 1030
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1001
Mailing Address - Country:US
Mailing Address - Phone:808-955-0788
Mailing Address - Fax:808-951-7233
Practice Address - Street 1:1319 PUNAHOU ST
Practice Address - Street 2:SUITE 1030
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1001
Practice Address - Country:US
Practice Address - Phone:808-955-0788
Practice Address - Fax:808-951-7233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2844207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI03651901Medicaid
HIC97836Medicare UPIN
HIH0000BDFVCMedicare PIN