Provider Demographics
NPI:1437102753
Name:ALUKO, GBENGA (MD)
Entity Type:Individual
Prefix:DR
First Name:GBENGA
Middle Name:
Last Name:ALUKO
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:PO BOX 667889
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28266-7889
Mailing Address - Country:US
Mailing Address - Phone:704-926-5434
Mailing Address - Fax:704-926-5439
Practice Address - Street 1:1951 OLD STEELE CREEK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-6080
Practice Address - Country:US
Practice Address - Phone:704-926-5434
Practice Address - Fax:704-926-5439
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200501333207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC14096OtherBLUECROSS BLUESHIELD
NC5902507Medicaid
SC278746Medicaid
NC14096OtherBLUECROSS BLUESHIELD
NC2051372KMedicare PIN
SC278746Medicaid