Basic Information
| Provider Information | |||||||||
| NPI: | 1760536759 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCGRATH | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75-1091 KAMALANI STREET | ||||||||
| Address2: | |||||||||
| City: | HOLUALOA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967251719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083344400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 75-1091 KAMALANI ST | ||||||||
| Address2: | |||||||||
| City: | HOLUALOA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967259646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083344400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 10/13/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MD - 9172 | HI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 0000202721 | 01 | HI | HMSA | OTHER | 075459-08 | 05 | HI | MEDICAID | 0000202721 | 05 | HI | MEDICAID | 00G0202726 | 01 | HI | HMSA BILLING NUMBER (KAISER) | OTHER | 07545902 | 01 | HI | ALOHA CARE | OTHER |