Healthcare Provider Details

I. General information

NPI: 1538237466
Provider Name (Legal Business Name): CARMEN K STANKO MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 LUSITANA ST SUITE 814
HONOLULU HI
96813-2421
US

IV. Provider business mailing address

1380 LUSITANA ST SUITE 814
HONOLULU HI
96813-2421
US

V. Phone/Fax

Practice location:
  • Phone: 808-521-3802
  • Fax:
Mailing address:
  • Phone: 808-521-3802
  • Fax: 808-521-1738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4913
License Number StateHI

VIII. Authorized Official

Name: CARMEN STANKO
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 808-521-3802