Provider Demographics
NPI:1114990256
Name:BOHNERT, PHILIP V (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:V
Last Name:BOHNERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 LEHUA ST
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-2036
Mailing Address - Country:US
Mailing Address - Phone:808-621-8411
Mailing Address - Fax:808-621-4117
Practice Address - Street 1:95390 KUAHELANI AVE
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789
Practice Address - Country:US
Practice Address - Phone:808-627-3200
Practice Address - Fax:808-623-7872
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD68952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIC78000OtherHMSA
HI05868401Medicaid
HIC78000OtherHMSA
HI05868401Medicaid