Basic Information
| Provider Information | |||||||||
| NPI: | 1619268455 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AFILAKA | ||||||||
| FirstName: | BUKOLA | ||||||||
| MiddleName: | O | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FALADE | ||||||||
| OtherFirstName: | BUKOLA | ||||||||
| OtherMiddleName: | O | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5445 PROVINE PL APT 806 | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713035801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6463129111 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3330 MASONIC DR | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713013841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184871122 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2011 | ||||||||
| LastUpdateDate: | 10/14/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 207169 | LA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.