Provider Demographics
NPI:1275586927
Name:ANNERUD, CAROLYN (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:
Last Name:ANNERUD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 MAIN STREET STE 300
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64105
Mailing Address - Country:US
Mailing Address - Phone:816-561-1025
Mailing Address - Fax:816-559-6339
Practice Address - Street 1:347 N. KUAKINI ST
Practice Address - Street 2:KUAKINI MEDICAL CENTER
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817
Practice Address - Country:US
Practice Address - Phone:808-547-9593
Practice Address - Fax:808-599-2714
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI7649207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI49616810Medicaid
HI49616809Medicaid
HI49616809Medicaid
HI49616810Medicaid
HI101360Medicare ID - Type Unspecified