Healthcare Provider Details

I. General information

NPI: 1437106887
Provider Name (Legal Business Name): DR. MOBOLAJI BABATOPE BAKARE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MOBOLAJI BAKARE M.D.

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 SILAS CREEK PKWY
WINSTON SALEM NC
27103-3013
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-718-8383
  • Fax: 336-718-9622
Mailing address:
  • Phone: 336-718-8383
  • Fax: 336-718-9622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2005-01273
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2005-01273
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: