Provider Demographics
NPI:1679595995
Name:LULE-KIWANUKA, ANNE (MD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:LULE-KIWANUKA
Suffix:
Gender:F
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1300 N UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-3456
Practice Address - Country:US
Practice Address - Phone:336-841-4683
Practice Address - Fax:336-888-6353
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2017-02634208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL121086Medicaid
GA000979558AMedicaid
NC1679595995Medicaid
GAPENDINGMedicare UPIN