Healthcare Provider Details

I. General information

NPI: 1225270325
Provider Name (Legal Business Name): ANTHONY LANE MICHAUD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2009
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PUNCHBOWL ST
HONOLULU HI
96813-2499
US

IV. Provider business mailing address

1301 PUNCHBOWL ST
HONOLULU HI
96813-2499
US

V. Phone/Fax

Practice location:
  • Phone: 808-691-1000
  • Fax:
Mailing address:
  • Phone: 808-691-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberA124219
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD18975
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: