| Wailea Medical Group Llc | |
|
161 Wailea Ike Pl #b102 Wailea HI 96753-6521 | |
| (808) 875-9095 | |
| (808) 875-9098 |
| Full Name | Wailea Medical Group Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 161 Wailea Ike Pl, Wailea, Hawaii |
| Authorized Official Name and Position | Gregory L Park (M.D.) |
| Authorized Official Contact | 8088759095 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wailea Medical Group Llc 161 Wailea Ike Pl B-102 Wailea HI 96753-6521 Ph: (808) 875-9095 | Wailea Medical Group Llc 161 Wailea Ike Pl #b102 Wailea HI 96753-6521 Ph: (808) 875-9095 |
| NPI Number | 1497769988 |
|---|---|
| Provider Enumeration Date | 07/28/2006 |
| Last Update Date | 09/16/2015 |
| Medicare PECOS PAC ID | 7618071101 |
|---|---|
| Medicare Enrollment ID | O20070322000089 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497769988 | NPI | - | NPPES |
| 045506-02 | Medicaid | HI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 3915 (Hawaii) | Primary |
| Provider Name | Gregory L Park |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1861497596 PECOS PAC ID: 3870483589 Enrollment ID: I20040614001422 |
| Provider Name | Maria-teresa David |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013914787 PECOS PAC ID: 2961422431 Enrollment ID: I20051129000539 |