Provider Demographics
NPI:1396211611
Name:BUKHARI PSYCHIATRIC SERVICES
Entity Type:Organization
Organization Name:BUKHARI PSYCHIATRIC SERVICES
Other - Org Name:SYED MUHAMMAD ALI IMRAN BUKHARI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED MUHAMMAD
Authorized Official - Middle Name:ALI IMRAN
Authorized Official - Last Name:BUKHARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-545-9902
Mailing Address - Street 1:3341 REGENT BLVD STE 130 #383
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3132
Mailing Address - Country:US
Mailing Address - Phone:903-331-0506
Mailing Address - Fax:903-331-0462
Practice Address - Street 1:425 OLD NEWMAN RD STE 402
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75036-8184
Practice Address - Country:US
Practice Address - Phone:817-900-2766
Practice Address - Fax:817-898-7402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-15
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX394698001Medicaid