Basic Information
| Provider Information | |||||||||
| NPI: | 1376545509 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUKHARI | ||||||||
| FirstName: | FAISAL | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 WEST ADAMS | ||||||||
| Address2: | |||||||||
| City: | SULLIVAN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 619511983 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2177287353 | ||||||||
| FaxNumber: | 2177282580 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 W ADAMS ST | ||||||||
| Address2: | |||||||||
| City: | SULLIVAN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 619511943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2177287353 | ||||||||
| FaxNumber: | 2177282580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2005 | ||||||||
| LastUpdateDate: | 03/05/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036088652 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 07021960 | 01 | IL | BCBS ILLINOIS | OTHER | 036088652 | 05 | IL | MEDICAID | 110242003 | 01 | IL | PALMETTO | OTHER |