Healthcare Provider Details

I. General information

NPI: 1982314241
Provider Name (Legal Business Name): BOKHARI MEDICAL CONSORTIUM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 SEMINOLE BLVD
LARGO FL
33770-3627
US

IV. Provider business mailing address

716 SEMINOLE BLVD
LARGO FL
33770-3627
US

V. Phone/Fax

Practice location:
  • Phone: 844-229-8671
  • Fax:
Mailing address:
  • Phone: 727-238-3241
  • Fax: 727-238-8402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HASSAN BOKHARI
Title or Position: MEDICAL DIRECTORY
Credential: MD
Phone: 844-229-8671