Healthcare Provider Details

I. General information

NPI: 1184622920
Provider Name (Legal Business Name): MICHAEL BORNEMANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 03/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2228 LILIHA ST 202
HONOLULU HI
96817-1650
US

IV. Provider business mailing address

2228 LILIHA ST 202
HONOLULU HI
96817-1650
US

V. Phone/Fax

Practice location:
  • Phone: 808-585-0741
  • Fax: 808-585-0743
Mailing address:
  • Phone: 808-585-0741
  • Fax: 808-585-0743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD8759
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: