Provider Demographics
NPI:1174622567
Name:STAHL, GLENN M (MD)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:M
Last Name:STAHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:46-001 KAMEHAMEHA HWY
Mailing Address - Street 2:SUITE 410
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3711
Mailing Address - Country:US
Mailing Address - Phone:808-235-3696
Mailing Address - Fax:
Practice Address - Street 1:46-001 KAMEHAMEHA HWY
Practice Address - Street 2:SUITE 410
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3711
Practice Address - Country:US
Practice Address - Phone:808-235-3696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2681207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI035452 01Medicaid
HIC97843Medicare UPIN
HI035452 01Medicaid