Provider Demographics
NPI:1114243474
Name:MAUI KIDNEY SPECIALIST LLC
Entity Type:Organization
Organization Name:MAUI KIDNEY SPECIALIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:808-280-9585
Mailing Address - Street 1:105 MAUILANI PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2443
Mailing Address - Country:US
Mailing Address - Phone:808-280-9585
Mailing Address - Fax:808-244-9577
Practice Address - Street 1:105 MAUILANI PKWY STE 100
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2443
Practice Address - Country:US
Practice Address - Phone:808-280-9585
Practice Address - Fax:808-244-9577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1208207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HID24533Medicare UPIN