MEDICARE: BUDDY KARL FESTERLING M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD - 10056	HI

General Provider Information

NPI Number	:	1396816567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BUDDY KARL FESTERLING M.D.

Provider Business Mailing Address
First Line	:	73 PUUHONU PL
Second Line	:	SUITE 200
City	:	HILO
State	:	HI
Zip	:	96720-2060
Country	:	US
Telephone Number	:	808-969-7922
Fax Number	:	808-934-2059

Provider Business Practice Location Address
First Line	:	73 PUUHONU PL
Second Line	:	SUITE 200
City	:	HILO
State	:	HI
Zip	:	96720-2060
Country	:	US
Telephone Number	:	808-969-7922
Fax Number	:	808-934-2059

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	07/08/2007

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