Provider Demographics
NPI:1023271954
Name:ADEFABI, BUKIE A (MD)
Entity type:Individual
Prefix:DR
First Name:BUKIE
Middle Name:A
Last Name:ADEFABI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 S MCDOWELL ST STE 125-1350
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2623
Mailing Address - Country:US
Mailing Address - Phone:803-855-1707
Mailing Address - Fax:803-274-2532
Practice Address - Street 1:17210 LANCASTER HWY STE 408
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2093
Practice Address - Country:US
Practice Address - Phone:803-855-1707
Practice Address - Fax:803-274-2532
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC51536207Q00000X
NC2014-02372207Q00000X, 207Q00000X
NY271415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP01522973Medicare PIN
NCNCO449AMedicare PIN