Healthcare Provider Details

I. General information

NPI: 1689598880
Provider Name (Legal Business Name): AIME MBAYA LUFULWABO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 CO OP DR
VAN BUREN AR
72956-6083
US

IV. Provider business mailing address

5016 FARMHOUSE ST
SPRINGDALE AR
72762-5395
US

V. Phone/Fax

Practice location:
  • Phone: 479-474-4249
  • Fax:
Mailing address:
  • Phone: 646-270-4503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP-0003
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: