Basic Information
| Provider Information | |||||||||
| NPI: | 1316905003 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUKHARI | ||||||||
| FirstName: | SYED | ||||||||
| MiddleName: | AZIM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | L-3549 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432600001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403837927 | ||||||||
| FaxNumber: | 7403837942 | ||||||||
| Practice Location | |||||||||
| Address1: | 1073 HARDING MEMORIAL PKWY | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MARION | ||||||||
| State: | OH | ||||||||
| PostalCode: | 433026363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403838579 | ||||||||
| FaxNumber: | 7403875244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2006 | ||||||||
| LastUpdateDate: | 10/07/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 35042809B | OH | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 35.042809 | OH | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 000000118378 | 01 | OH | ANTTHEM | OTHER | 637381 | 01 | AETNA | OTHER | 353077 | 01 | SUBMITTER NO. | OTHER | 0431965 | 05 | OH | MEDICAID | 311098079 | 01 | TAX ID # | OTHER | 1200699 | 01 | UHC | OTHER | 311098079 | 01 | CIGNA | OTHER |