Provider Demographics
NPI:1629010590
Name:HUBER, MICHELLE R (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:R
Last Name:HUBER
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:PO BOX 2257
Mailing Address - Street 2:
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750-2257
Mailing Address - Country:US
Mailing Address - Phone:808-345-4833
Mailing Address - Fax:808-443-0365
Practice Address - Street 1:79-1019 HAUKAPILA STREET
Practice Address - Street 2:
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750-7290
Practice Address - Country:US
Practice Address - Phone:808-344-4833
Practice Address - Fax:808-443-0365
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-9886207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00F0211562OtherHMSA
HI08684404Medicaid
HI4909653OtherUNIVERSITY HEALTH ALLIANC
HIG60250Medicare UPIN
HIH100742Medicare ID - Type UnspecifiedMEDICARE