Provider Demographics
NPI:1225076227
Name:BUKHARI, RIZWAN HASSAN (MD)
Entity Type:Individual
Prefix:
First Name:RIZWAN
Middle Name:HASSAN
Last Name:BUKHARI
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 1:3220 GUS THOMASSON RD STE 231
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4051
Mailing Address - Country:US
Mailing Address - Phone:972-885-8346
Mailing Address - Fax:214-466-1976
Practice Address - Street 1:3220 GUS THOMASSON RD STE 231
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150
Practice Address - Country:US
Practice Address - Phone:972-885-8346
Practice Address - Fax:214-466-1976
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX36999301Medicaid
TX368029ZJTQMedicare PIN
TXG61140Medicare UPIN