Provider Demographics
NPI:1306434220
Name:MAKENA HEALTH
Entity type:Organization
Organization Name:MAKENA HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:STARBUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-633-5539
Mailing Address - Street 1:2748 AKALANI LOOP
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-8410
Mailing Address - Country:US
Mailing Address - Phone:808-633-5539
Mailing Address - Fax:
Practice Address - Street 1:161 WAILEA IKE PL STE B102
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-6502
Practice Address - Country:US
Practice Address - Phone:808-875-9095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-06
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty