Provider Demographics
NPI:1205868361
Name:MELISH, JOHN STEPHENS (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:STEPHENS
Last Name:MELISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1319 PUNAHOU STREET
Mailing Address - Street 2:SUITE 1040
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1028
Mailing Address - Country:US
Mailing Address - Phone:808-949-2304
Mailing Address - Fax:808-951-7004
Practice Address - Street 1:1319 PUNAHOU STREET
Practice Address - Street 2:SUITE 1040
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1028
Practice Address - Country:US
Practice Address - Phone:808-949-2304
Practice Address - Fax:808-951-7004
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD3112207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI03869701Medicaid
HI0000BDGGKMedicare PIN
HI0000BDGGKMedicare ID - Type Unspecified