Individual
SHANE J MILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AMD
Contact information
Practice address
130 KAILUA RD, SUITE 111, KAILUA, HI 96734-3420
(808) 261-4411
(808) 466-3354
Mailing address
130 KAILUA RD, SUITE 111, KAILUA, HI 96734-3420
(808) 261-4411
(808) 261-3322
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
AMD 240
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000250415
HMSA
HI
01
—
56774501
ALOHA CARE
HI
05
—
56774501
—
HI
Enumeration date
11/18/2005
Last updated
05/08/2023
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