Provider Demographics
NPI:1417062092
Name:MEK MD INC
Entity Type:Organization
Organization Name:MEK MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:KRUGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-734-1130
Mailing Address - Street 1:929 KOAE ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5004
Mailing Address - Country:US
Mailing Address - Phone:808-734-1130
Mailing Address - Fax:808-734-4425
Practice Address - Street 1:929 KOAE ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5004
Practice Address - Country:US
Practice Address - Phone:808-734-1130
Practice Address - Fax:808-734-4425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHI12656207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI54750702Medicaid
HI00B0245072OtherHMSA
HI54750702Medicaid
HI00B0245072OtherHMSA