Individual
ABINET BOKU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-5784
(336) 716-2255
Mailing address
18912 HENRY LEE KNOX LN, CORNELIUS, NC 28031-5784
(414) 238-4181
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2009-01476
NC
208M00000X
Hospitalist Physician
Primary
2009-01476
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1477731248
—
NC
05
—
5918100
—
NC
05
—
NC1446
—
SC
Enumeration date
02/04/2008
Last updated
05/04/2018
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