Healthcare Provider Details

I. General information

NPI: 1407873037
Provider Name (Legal Business Name): JOHN HENRY BUZANOSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 N KUAKINI ST HPM 9
HONOLULU HI
96817-2336
US

IV. Provider business mailing address

2465 ALA WAI BLVD SUITE 803
HONOLULU HI
96815-3432
US

V. Phone/Fax

Practice location:
  • Phone: 808-523-8461
  • Fax: 808-528-1897
Mailing address:
  • Phone: 808-926-9995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number10222
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: