Healthcare Provider Details

I. General information

NPI: 1164595229
Provider Name (Legal Business Name): ALOHA FAMILY PRACTICE CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 04/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 DICKENSON ST SUITE 103
LAHAINA HI
96761-1215
US

IV. Provider business mailing address

180 DICKENSON ST SUITE 103
LAHAINA HI
96761-1215
US

V. Phone/Fax

Practice location:
  • Phone: 808-662-5642
  • Fax: 808-662-5642
Mailing address:
  • Phone: 808-662-5642
  • Fax: 808-662-5642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberMD6743
License Number StateHI

VIII. Authorized Official

Name: MR. DOUGLAS JOHN SCHUSSER
Title or Position: GENERAL MANAGER
Credential:
Phone: 808-662-5642