Provider Demographics
NPI:1982709531
Name:BUHARIWALLA, REESHAD RUSI (MD)
Entity Type:Individual
Prefix:DR
First Name:REESHAD
Middle Name:RUSI
Last Name:BUHARIWALLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 HASKINS RD STE B
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-1600
Mailing Address - Country:US
Mailing Address - Phone:419-373-7607
Mailing Address - Fax:419-353-7076
Practice Address - Street 1:1037 CONNEAUT AVE STE 206
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-5300
Practice Address - Country:US
Practice Address - Phone:419-353-6225
Practice Address - Fax:419-354-0922
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-8953207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0217269Medicaid
OH000000130577OtherANTHEM
OH080123688OtherRAILROAD MEDICARE
OHH562810OtherMEDICARE
OH08-01306OtherUNITED HEALTHCARE
OH000000130577OtherANTHEM