Provider Demographics
NPI:1205050655
Name:BOKHARI, S ISMAIL AH SR (MD)
Entity type:Individual
Prefix:DR
First Name:S ISMAIL
Middle Name:AH
Last Name:BOKHARI
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:890 AIRWAY AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3588
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
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11041207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ206640Medicaid
AZZWMBJY01Medicare PIN
AZC99178Medicare UPIN