Provider Demographics
NPI:1306954847
Name:MANIQUIS-SMIGEL, LIZA R (MD)
Entity type:Individual
Prefix:
First Name:LIZA
Middle Name:R
Last Name:MANIQUIS-SMIGEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LIZA
Other - Middle Name:ROSELA
Other - Last Name:MANIQUIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:136A ULULANI ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2946
Mailing Address - Country:US
Mailing Address - Phone:808-933-3444
Mailing Address - Fax:808-933-3433
Practice Address - Street 1:136A ULULANI ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2946
Practice Address - Country:US
Practice Address - Phone:808-933-3444
Practice Address - Fax:808-933-3433
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 10575208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI362562300OtherACS
HI00C022405-9OtherHAWAII MEDICAL SVC ASSOC
HI248808-04Medicaid
HIH93832Medicare UPIN
HIH55528Medicare PIN