Provider Demographics
NPI:1730100132
Name:BUKEIRAT, FAISAL AHMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:FAISAL
Middle Name:AHMAD
Last Name:BUKEIRAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FAISAL
Other - Middle Name:A
Other - Last Name:BUKEIRAT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, FACG
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:ONE HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-882-1434
Practice Address - Fax:573-884-2290
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17445207RG0100X, 207RI0008X
FLME117348207RG0100X
MO2021049915207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0125879000Medicaid
WV0125879000Medicaid
F67477Medicare UPIN