Provider Demographics
NPI:1669831913
Name:HAWAII METABOLIC MANAGEMENT, LLC
Entity Type:Organization
Organization Name:HAWAII METABOLIC MANAGEMENT, LLC
Other - Org Name:OSR WEIGHT MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-488-5555
Mailing Address - Street 1:970 N KALAHEO AVE
Mailing Address - Street 2:SUITE C-316
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1866
Mailing Address - Country:US
Mailing Address - Phone:808-488-5555
Mailing Address - Fax:808-356-0664
Practice Address - Street 1:970 N KALAHEO AVE
Practice Address - Street 2:SUITE C-316
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1866
Practice Address - Country:US
Practice Address - Phone:808-488-5555
Practice Address - Fax:808-356-0664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI207RB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Single Specialty