Healthcare Provider Details

I. General information

NPI: 1649385063
Provider Name (Legal Business Name): STEPHEN LOUIS CERKAS P.A. -C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 B KAALAIKI ROAD
NAALEHU HI
96772-0590
US

IV. Provider business mailing address

PO BOX 94 94 6614 KUAMOO STREET
NAALEHU HI
96772-0094
US

V. Phone/Fax

Practice location:
  • Phone: 808-929-7331
  • Fax:
Mailing address:
  • Phone: 808-929-8349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberAMD 129
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: