Provider Demographics
NPI:1992798391
Name:BUKHARI, ATHER M (MD)
Entity type:Individual
Prefix:DR
First Name:ATHER
Middle Name:M
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 1:3903 HOLLYWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:ST JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085
Mailing Address - Country:US
Mailing Address - Phone:269-408-1100
Mailing Address - Fax:269-408-1350
Practice Address - Street 1:3903 HOLLYWOOD RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9149
Practice Address - Country:US
Practice Address - Phone:269-408-1100
Practice Address - Fax:269-408-1329
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2011-02-15
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
MI4301077149207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4359100Medicaid
MI4301077149OtherSTATE LICENSE
MI4301077149OtherSTATE LICENSE
MIG77979Medicare UPIN