Provider Demographics
NPI:1427112515
Name:KAWIMBE, BONIFACE M (MD)
Entity type:Individual
Prefix:
First Name:BONIFACE
Middle Name:M
Last Name:KAWIMBE
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 1:417 NORTH ST
Mailing Address - Street 2:APT #17
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4606
Mailing Address - Country:US
Mailing Address - Phone:203-685-3987
Mailing Address - Fax:
Practice Address - Street 1:BERKSHIRE MEDICAL CENTER
Practice Address - Street 2:725 NORTH STREET
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201
Practice Address - Country:US
Practice Address - Phone:203-685-3987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47880208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery