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General NPI Number Information
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NPI Number | 1295265221
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Entity Type | Organization
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Legal Business Name | MOBOLAJI BABATOPE BAKARE MD PC
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Dates
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Enumeration Date | 06/13/2017
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Last Update Date | 07/31/2017
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Provider Practice Location Address
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Address Line | 3411 W WENDOVER AVE STE D
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City | GREENSBORO
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State | NC
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Zip | 27407-1526
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Country | US
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Telephone | 336-558-4665
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 39175
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City | GREENSBORO
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State | NC
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Zip | 27438-9175
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Country | US
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Telephone | 336-558-4665
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MOBOLAJI B. BAKARE
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Credential | MD
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Telephone | 336-558-4665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2005-01273
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License Number State | NC
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