Healthcare Provider Details

I. General information

NPI: 1376513887
Provider Name (Legal Business Name): WILLIAM ELY BURKHALTER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST STE 630
HONOLULU HI
96826-1044
US

IV. Provider business mailing address

192 AIKAHI LOOP
KAILUA HI
96734-1642
US

V. Phone/Fax

Practice location:
  • Phone: 808-945-3766
  • Fax: 808-942-9837
Mailing address:
  • Phone: 808-254-9323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number10948
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: