Healthcare Provider Details

I. General information

NPI: 1205868361
Provider Name (Legal Business Name): JOHN STEPHENS MELISH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU STREET SUITE 1040
HONOLULU HI
96826-1028
US

IV. Provider business mailing address

1319 PUNAHOU STREET SUITE 1040
HONOLULU HI
96826-1028
US

V. Phone/Fax

Practice location:
  • Phone: 808-949-2304
  • Fax: 808-951-7004
Mailing address:
  • Phone: 808-949-2304
  • Fax: 808-951-7004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD3112
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD3112
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: