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General NPI Number Information
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NPI Number | 1134496086
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Entity Type | Organization
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Legal Business Name | LANIPO VILLAGE ANESTHESIA LLC
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Dates
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Enumeration Date | 11/21/2011
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Last Update Date | 11/21/2011
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Provider Practice Location Address
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Address Line | 151 LANIPO DR
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City | KAILUA
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State | HI
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Zip | 96734-3228
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Country | US
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Telephone | 808-721-2685
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Fax | 808-263-1013
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Provider Business Mailing Address
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Address Line | 151 LANIPO DR
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City | KAILUA
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State | HI
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Zip | 96734-3228
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Country | US
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Telephone | 808-721-2685
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Fax | 808-263-1013
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Authorized Official
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Title or Position | MEMBER
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Name | JOHN RAUSCH
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Credential | MD
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Telephone | 808-721-2685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD05461
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License Number State | HI
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