Individual
KOFI BRUCE MENSAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
851 DURHAM ROAD, SUITE D, WAKE FOREST, NC 27587-8793
(919) 554-0900
(336) 784-1116
Mailing address
851 DURHAM ROAD, SUITE D, WAKE FOREST, NC 27587-8793
(919) 554-0900
(336) 784-1116
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01429
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2333540
MEDICARE GROUP
—
05
—
891301P
—
NC
01
—
DD7390
RR GROUP
—
01
—
P00247762
RR MEDICARE IND
—
Enumeration date
12/05/2005
Last updated
08/15/2014
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