Provider Demographics
NPI:1104002054
Name:MKONO, WAMBURA NEEMA (MD)
Entity Type:Individual
Prefix:DR
First Name:WAMBURA
Middle Name:NEEMA
Last Name:MKONO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6615 W. BOYNTON BEACH BLVD PMB 101
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3536
Mailing Address - Country:US
Mailing Address - Phone:561-777-5308
Mailing Address - Fax:561-303-2131
Practice Address - Street 1:10075 S JOG RD STE 202
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3536
Practice Address - Country:US
Practice Address - Phone:561-777-5308
Practice Address - Fax:561-303-2131
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110611207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFN789XMedicare PIN