Provider Demographics
NPI:1891748620
Name:MCGILL, KEVIN T (CO, BOC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:T
Last Name:MCGILL
Suffix:
Gender:M
Credentials:CO, BOC
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 1156
Mailing Address - Street 2:
Mailing Address - City:HONOKAA
Mailing Address - State:HI
Mailing Address - Zip Code:96727-1156
Mailing Address - Country:US
Mailing Address - Phone:808-775-0814
Mailing Address - Fax:808-775-0645
Practice Address - Street 1:45-3290 OHIA ST
Practice Address - Street 2:SUITE 2
Practice Address - City:HONOKAA
Practice Address - State:HI
Practice Address - Zip Code:96727-6931
Practice Address - Country:US
Practice Address - Phone:808-775-0814
Practice Address - Fax:808-775-0645
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIW05946726174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI218529OtherHMSA
HI0000218529OtherHMSA QUEST
HI49582101Medicaid
HI218529OtherHMSA