Healthcare Provider Details

I. General information

NPI: 1356153316
Provider Name (Legal Business Name): BOKHARI MEDICAL CONSORTIUM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
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: 727-238-3241
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HASSAN AYAZ BOKHARI
Title or Position: OWNER
Credential:
Phone: 727-238-3241