Provider Demographics
NPI:1346355757
Name:OKAFOR, BONIFACE CHIKE (MD)
Entity Type:Individual
Prefix:DR
First Name:BONIFACE
Middle Name:CHIKE
Last Name:OKAFOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8109 AMBER CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-6979
Mailing Address - Country:US
Mailing Address - Phone:334-279-9748
Mailing Address - Fax:
Practice Address - Street 1:215 PERRY HILL RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36109-3725
Practice Address - Country:US
Practice Address - Phone:334-272-4670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20683207R00000X
GA039710207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH74457Medicare UPIN