Healthcare Provider Details

I. General information

NPI: 1548582539
Provider Name (Legal Business Name): KERIC MENES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2010
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 S BERETANIA ST SUITE 201-202
HONOLULU HI
96826-1149
US

IV. Provider business mailing address

1575 S BERETANIA ST SUITE 201-202
HONOLULU HI
96826-1149
US

V. Phone/Fax

Practice location:
  • Phone: 808-946-1712
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number18583
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: