Wailea Medical Group LLC

NPI #1497769988 in Wailea, Hawaii

Provider Information

NPI Number: 1497769988
Entity Type: Organization
Organization Name: Wailea Medical Group LLC
Primary Specialty: Internal Medicine
Enumeration Date: Jul 28, 2006
Last Updated: Sep 16, 2015

Practice Location

Address: 161 WAILEA IKE PL
Address 2: #B102
City: Wailea
State: Hawaii
ZIP Code: 96753-6521
Phone: (808) 875-9095

Authorized Official

Name: MR. GREGORY L PARK, MD
Title: M.D.
Phone: (808) 875-9095

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X	Primary

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