1396211611 NPI number — BUKHARI PSYCHIATRIC SERVICES

Table of content: (NPI 1396211611)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396211611 NPI number — BUKHARI PSYCHIATRIC SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUKHARI PSYCHIATRIC SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SYED MUHAMMAD ALI IMRAN BUKHARI
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396211611
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3341 REGENT BLVD STE 130 #383
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75063-3132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-331-0506
Provider Business Mailing Address Fax Number:
903-331-0462

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 OLD NEWMAN RD STE 402
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75036-8184
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-900-2766
Provider Business Practice Location Address Fax Number:
817-898-7402
Provider Enumeration Date:
10/15/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BUKHARI
Authorized Official First Name:
SYED MUHAMMAD
Authorized Official Middle Name:
ALI IMRAN
Authorized Official Title or Position:
MEDICAL DOCTOR/OWNER
Authorized Official Telephone Number:
347-545-9902

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 394698001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".