Provider Demographics
NPI:1689767444
Name:S ISMAIL AH BOKHARI, MD, PC
Entity Type:Organization
Organization Name:S ISMAIL AH BOKHARI, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN,OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:ISMAIL
Authorized Official - Last Name:BOKHARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-757-1333
Mailing Address - Street 1:1720 E BEVERLY AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3567
Mailing Address - Country:US
Mailing Address - Phone:928-757-1333
Mailing Address - Fax:928-757-2367
Practice Address - Street 1:1720 E BEVERLY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3567
Practice Address - Country:US
Practice Address - Phone:928-757-1333
Practice Address - Fax:928-757-2367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11041207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ206640Medicaid
AZ206640Medicaid
AZZWMBJYMedicare PIN