Healthcare Provider Details

I. General information

NPI: 1063694594
Provider Name (Legal Business Name): FRANK J MACALI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54-014 KUKUNA ST APT B
HAUULA HI
96717-8611
US

IV. Provider business mailing address

54-014 KUKUNA ST APT B
HAUULA HI
96717-8611
US

V. Phone/Fax

Practice location:
  • Phone: 808-647-0669
  • Fax:
Mailing address:
  • Phone: 808-647-0669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberAMD53
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: