Provider Demographics
NPI:1669776829
Name:FAISAL BUKHARI MD SC
Entity type:Organization
Organization Name:FAISAL BUKHARI MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:FAISAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUKHARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-728-7353
Mailing Address - Street 1:2 W. ADAMS
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IL
Mailing Address - Zip Code:61951-1943
Mailing Address - Country:US
Mailing Address - Phone:217-728-7353
Mailing Address - Fax:217-728-2580
Practice Address - Street 1:2 W. ADAMS
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IL
Practice Address - Zip Code:61951-1943
Practice Address - Country:US
Practice Address - Phone:217-728-7353
Practice Address - Fax:217-728-2580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088652207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036088652Medicaid
IL036088652Medicaid