=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831242189
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | M KATHRYN SCHAEFER MD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2007
-----------------------------------------------------
Last Update Date | 05/01/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 850 W HIND DR STE 102
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96821-1845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-261-1121
-----------------------------------------------------
Fax | 244-265-1495
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1585 KAPIOLANI BLVD SUITE 1800
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96814-4522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-261-1121
-----------------------------------------------------
Fax | 808-262-0045
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROPRIETOR
-----------------------------------------------------
Name | DR. MARY KATHRYN SCHAEFER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 808-261-1121
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MD-12075
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------