MEDICARE: JOSEPH R MCKINLAY MD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207NS0135X	Procedural Dermatology Physician	MD-10939	HI

General Provider Information

NPI Number	:	1134238173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH R MCKINLAY MD LLC

Provider Business Mailing Address
First Line	:	1003 BISHOP ST, PAUAHI TOWER
Second Line	:	SUITE #380
City	:	HONOLULU
State	:	HI
Zip	:	96813-3429
Country	:	US
Telephone Number	:	808-528-1717
Fax Number	:	808-528-1719

Provider Business Practice Location Address
First Line	:	1003 BISHOP ST, PAUAHI TOWER
Second Line	:	SUITE #380
City	:	HONOLULU
State	:	HI
Zip	:	96813-3429
Country	:	US
Telephone Number	:	808-528-1717
Fax Number	:	808-528-1719

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH R MCKINLAY
Credential	:	M.D.
Telephone Number	:	808-528-1717

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/11/2007

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