Provider Demographics
NPI:1215005590
Name:ZANONI, MICHAEL M (LAC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:M
Last Name:ZANONI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22471
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96823-2471
Mailing Address - Country:US
Mailing Address - Phone:808-225-2754
Mailing Address - Fax:
Practice Address - Street 1:1760 S BERETANIA ST APT 14D
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1134
Practice Address - Country:US
Practice Address - Phone:808-225-2754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC410171100000X
HIAC814171100000X
WAAC1865171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORAC410OtherLICENSE
MTAC159OtherLICENSE
WAAC1865OtherLICENSE
HIAC814OtherLICENSE