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General NPI Number Information
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NPI Number | 1760554836
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Entity Type | Organization
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Legal Business Name | MAUI NEUROLOGICAL ASSOCIATES INC
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 89 HOOKELE STREET SUITE 204
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City | KAHULUI
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State | HI
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Zip | 96732-3532
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Country | US
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Telephone | 808-877-5811
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Fax | 808-877-3146
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Provider Business Mailing Address
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Address Line | 89 HOOKELE STREET SUITE 204
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City | KAHULUI
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State | HI
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Zip | 96732-3532
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Country | US
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Telephone | 808-877-5811
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Fax | 808-877-3146
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Authorized Official
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Title or Position | PRESIDENT
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Name | LORNE KENNETH DIRENFELD
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Credential | MD
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Telephone | 808-877-5811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD4611
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License Number State | HI
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