Provider Demographics
NPI:1457308736
Name:BUKSH, AHMED BILAL (DPM)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:BILAL
Last Name:BUKSH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2553 S KELLY AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3888
Mailing Address - Country:US
Mailing Address - Phone:405-285-7408
Mailing Address - Fax:405-340-7077
Practice Address - Street 1:2553 S KELLY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3888
Practice Address - Country:US
Practice Address - Phone:405-285-7408
Practice Address - Fax:405-340-7077
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK199213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3903200001OtherMEDICARE DMERC
OK249231001Medicare ID - Type Unspecified
OK3903200001OtherMEDICARE DMERC
OK249231001Medicare ID - Type Unspecified