Provider Demographics
NPI:1255089157
Name:ADELANTE HEALTH MAUI
Entity type:Organization
Organization Name:ADELANTE HEALTH MAUI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEARNS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-648-4043
Mailing Address - Street 1:290 KAI MALU DR
Mailing Address - Street 2:
Mailing Address - City:WAILEA
Mailing Address - State:HI
Mailing Address - Zip Code:96753-6516
Mailing Address - Country:US
Mailing Address - Phone:209-648-4043
Mailing Address - Fax:
Practice Address - Street 1:161 WAILEA IKE PL
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-6521
Practice Address - Country:US
Practice Address - Phone:209-648-4043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty