Provider Demographics
NPI:1821165218
Name:BUKATE MEDICAL SUPPLIER
Entity Type:Organization
Organization Name:BUKATE MEDICAL SUPPLIER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:EKEREUKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-645-2969
Mailing Address - Street 1:5832 W SAN MIGUEL AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-5907
Mailing Address - Country:US
Mailing Address - Phone:623-877-1221
Mailing Address - Fax:623-435-1288
Practice Address - Street 1:5832 W SAN MIGUEL AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-5907
Practice Address - Country:US
Practice Address - Phone:623-877-1221
Practice Address - Fax:623-435-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4399820001Medicare NSC