MEDICARE: MR. KAIEA LA'IKU VERA ATC

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	2255A2300X	Athletic Trainer	3306-39	WI

General Provider Information

NPI Number	:	1700738671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KAIEA LA'IKU VERA ATC

Provider Business Mailing Address
First Line	:	10900 W BLUEMOUND RD APT 301
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-4145
Country	:	US
Telephone Number	:	808-937-0494
Fax Number	:

Provider Business Practice Location Address
First Line	:	807 PLEASANT VALLEY RD
Second Line	:
City	:	WEST BEND
State	:	WI
Zip	:	53095-9767
Country	:	US
Telephone Number	:	904-477-4238
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	02/12/2026

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