Basic Information
| Provider Information | |||||||||
| NPI: | 1669776829 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAISAL BUKHARI MD SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 W. ADAMS | ||||||||
| Address2: | |||||||||
| City: | SULLIVAN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 619511943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2177287353 | ||||||||
| FaxNumber: | 2177282580 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 W. ADAMS | ||||||||
| Address2: | |||||||||
| City: | SULLIVAN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 619511943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2177287353 | ||||||||
| FaxNumber: | 2177282580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2011 | ||||||||
| LastUpdateDate: | 01/03/2011 | ||||||||
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| AuthorizedOfficialLastName: | BUKHARI | ||||||||
| AuthorizedOfficialFirstName: | FAISAL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 2177287353 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036088652 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036088652 | 05 | IL | MEDICAID |