Provider Demographics
NPI:1164075040
Name:MAUI INTEGRATIVE MEDICINE
Entity Type:Organization
Organization Name:MAUI INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELSO BINZAK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:310-529-6891
Mailing Address - Street 1:72 MANO DR
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790-8527
Mailing Address - Country:US
Mailing Address - Phone:310-529-6891
Mailing Address - Fax:
Practice Address - Street 1:233 S MARKET ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2218
Practice Address - Country:US
Practice Address - Phone:310-529-6891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service