MEDICARE: BENJAMIN O. AKIWUMI, MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	9900005	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	9900005	OTHER	NC	LICENSE

General Provider Information

NPI Number	:	1952695397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENJAMIN O. AKIWUMI, MD

Provider Business Mailing Address
First Line	:	PO BOX 1579
Second Line	:
City	:	BURGAW
State	:	NC
Zip	:	28425-1579
Country	:	US
Telephone Number	:	910-300-9220
Fax Number	:	910-300-9270

Provider Business Practice Location Address
First Line	:	105 W COURTHOUSE AVE
Second Line	:
City	:	BURGAW
State	:	NC
Zip	:	28425-0000
Country	:	US
Telephone Number	:	910-300-9220
Fax Number	:	910-300-9270

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	BENJAMIN OLUFEMI AKIWUMI
Credential	:	M.D.
Telephone Number	:	910-300-9220

Provider Enumeration Date	:	06/02/2011
Last Update Date	:	03/14/2012

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