Provider Demographics
NPI:1376545509
Name:BUKHARI, FAISAL (MD SC)
Entity Type:Individual
Prefix:
First Name:FAISAL
Middle Name:
Last Name:BUKHARI
Suffix:
Gender:M
Credentials:MD SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WEST ADAMS
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IL
Mailing Address - Zip Code:61951-1983
Mailing Address - Country:US
Mailing Address - Phone:217-728-7353
Mailing Address - Fax:217-728-2580
Practice Address - Street 1:2 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IL
Practice Address - Zip Code:61951-1943
Practice Address - Country:US
Practice Address - Phone:217-728-7353
Practice Address - Fax:217-728-2580
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088652207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL07021960OtherBCBS ILLINOIS
IL036088652Medicaid
IL110242003OtherPALMETTO
IL036088652Medicaid
ILG04379Medicare UPIN
IL036088652Medicaid