Provider Demographics
NPI:1225298011
Name:KUBOYE, KOFOWOROLA MARIAM (MD)
Entity Type:Individual
Prefix:
First Name:KOFOWOROLA
Middle Name:MARIAM
Last Name:KUBOYE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6587 VIRGINIA PKWY
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-5511
Mailing Address - Country:US
Mailing Address - Phone:972-548-8382
Mailing Address - Fax:
Practice Address - Street 1:6587 VIRGINIA PKWY
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-5511
Practice Address - Country:US
Practice Address - Phone:972-548-8382
Practice Address - Fax:972-547-9951
Is Sole Proprietor?:No
Enumeration Date:2008-06-15
Last Update Date:2023-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS217562080A0000X
390200000X
TXQ6050208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program