Provider Demographics
NPI:1235184623
Name:SERGIO A. LUGO M.D. INC.
Entity Type:Organization
Organization Name:SERGIO A. LUGO M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-244-6776
Mailing Address - Street 1:1885 MAIN ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1819
Mailing Address - Country:US
Mailing Address - Phone:808-244-6776
Mailing Address - Fax:808-244-6005
Practice Address - Street 1:1885 MAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1819
Practice Address - Country:US
Practice Address - Phone:808-244-6776
Practice Address - Fax:808-244-6005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD9805174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI49332001Medicaid
HIG64334Medicare UPIN
HI49332001Medicaid