Healthcare Provider Details

I. General information

NPI: 1821165218
Provider Name (Legal Business Name): BUKATE MEDICAL SUPPLIER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5832 W SAN MIGUEL AVE SUITE 3
GLENDALE AZ
85301-5907
US

IV. Provider business mailing address

5832 W SAN MIGUEL AVE SUITE 3
GLENDALE AZ
85301-5907
US

V. Phone/Fax

Practice location:
  • Phone: 623-877-1221
  • Fax: 623-435-1288
Mailing address:
  • Phone: 623-877-1221
  • Fax: 623-435-1288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateAZ

VIII. Authorized Official

Name: CATHERINE EKEREUKE
Title or Position: PRESIDENT
Credential:
Phone: 818-645-2969