Provider Demographics
NPI:1316905003
Name:BUKHARI, SYED AZIM (MD)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:AZIM
Last Name:BUKHARI
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:L-3549
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43260-0001
Mailing Address - Country:US
Mailing Address - Phone:740-383-7927
Mailing Address - Fax:740-383-7942
Practice Address - Street 1:1073 HARDING MEMORIAL PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6363
Practice Address - Country:US
Practice Address - Phone:740-383-8579
Practice Address - Fax:740-387-5244
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35042809B208000000X
OH35.042809208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000118378OtherANTTHEM
637381OtherAETNA
353077OtherSUBMITTER NO.
OH0431965Medicaid
311098079OtherTAX ID #
1200699OtherUHC
311098079OtherCIGNA
1200699OtherUHC
353077OtherSUBMITTER NO.