Provider Demographics
NPI:1255343430
Name:SUMMERS, KEITH E (MD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:E
Last Name:SUMMERS
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 1:1575 SOUTH BERETANIA STREET #201 #202
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1149
Mailing Address - Country:US
Mailing Address - Phone:808-946-1712
Mailing Address - Fax:808-946-1728
Practice Address - Street 1:1575 SOUTH BERETANIA STREET #201 #202
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1149
Practice Address - Country:US
Practice Address - Phone:808-946-1712
Practice Address - Fax:808-946-1728
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4598207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIA1232 6OtherHMSA
HI01175801Medicaid
C97628Medicare UPIN
HIA1232 6OtherHMSA