Provider Demographics
NPI:1336302264
Name:MUFUKA, GABRIEL BEZEL (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:BEZEL
Last Name:MUFUKA
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 1:1818 N MEADE ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-3454
Mailing Address - Country:US
Mailing Address - Phone:920-731-8900
Mailing Address - Fax:920-225-1404
Practice Address - Street 1:1116 11TH ST SW
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-3608
Practice Address - Country:US
Practice Address - Phone:800-818-2180
Practice Address - Fax:888-972-6794
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99456207RC0000X
WI73699207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCC994ZMedicare PIN
FLCC994YMedicare PIN