Provider Demographics
NPI:1104097534
Name:CRAIG Y. SHIKUMA, M.D., INC.
Entity type:Organization
Organization Name:CRAIG Y. SHIKUMA, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:YOSHIHIRO
Authorized Official - Last Name:SHIKUMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-935-5522
Mailing Address - Street 1:82 PUUHONU PLACE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2010
Mailing Address - Country:US
Mailing Address - Phone:808-935-5522
Mailing Address - Fax:808-961-5058
Practice Address - Street 1:82 PUUHONU PL
Practice Address - Street 2:SUITE 207
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2010
Practice Address - Country:US
Practice Address - Phone:808-935-5522
Practice Address - Fax:808-961-5058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3967207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI521650Medicaid
HI521650Medicaid