Provider Demographics
NPI:1184622920
Name:BORNEMANN, MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:BORNEMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2228 LILIHA ST
Mailing Address - Street 2:202
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1650
Mailing Address - Country:US
Mailing Address - Phone:808-585-0741
Mailing Address - Fax:808-585-0743
Practice Address - Street 1:2228 LILIHA ST
Practice Address - Street 2:202
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1650
Practice Address - Country:US
Practice Address - Phone:808-585-0741
Practice Address - Fax:808-585-0743
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2013-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD8759174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI53686OtherBCBS
HIMD8759OtherQHP/MDX
HI04724403Medicaid
HI53686OtherHMSA
HIF92081Medicare UPIN
HI04724403Medicaid