Healthcare Provider Details

I. General information

NPI: 1770779274
Provider Name (Legal Business Name): KIHEI CLINIC AND WAILEA MEDICAL SERVICES, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2349 S KIHEI RD SUITE D
KIHEI HI
96753-7202
US

IV. Provider business mailing address

2349 S KIHEI RD SUITE D
KIHEI HI
96753-7202
US

V. Phone/Fax

Practice location:
  • Phone: 808-879-1440
  • Fax: 808-879-7447
Mailing address:
  • Phone:
  • Fax: 808-879-7447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License NumberMD7001
License Number StateHI

VIII. Authorized Official

Name: DR. ELMER HARRY RATZLAFF
Title or Position: PRESIDENT
Credential: M.D.
Phone: 808-879-1440