Healthcare Provider Details

I. General information

NPI: 1245209162
Provider Name (Legal Business Name): WINDWARD ORTHOPAEDIC GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 09/28/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 AULIKE ST SUITE 506
KAILUA HI
96734-2739
US

IV. Provider business mailing address

30 AULIKE ST STE 201
KAILUA HI
96734-2750
US

V. Phone/Fax

Practice location:
  • Phone: 808-261-4658
  • Fax: 808-263-2036
Mailing address:
  • Phone: 808-261-4658
  • Fax: 808-263-2036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JENNIFER M PRIMACIO
Title or Position: BUSINESS MANAGER
Credential:
Phone: 808-203-6606