Provider Demographics
NPI:1457434318
Name:BRUNEL, WILEY (MD)
Entity type:Individual
Prefix:
First Name:WILEY
Middle Name:
Last Name:BRUNEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 ULUKAHIKI ST STE 203
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4418
Mailing Address - Country:US
Mailing Address - Phone:808-678-2211
Mailing Address - Fax:
Practice Address - Street 1:642 ULUKAHIKI ST STE 203
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4418
Practice Address - Country:US
Practice Address - Phone:808-678-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD7357208600000X, 2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI06157701Medicaid
HIH0000BDSJQMedicare ID - Type Unspecified
HIE76874Medicare UPIN