Healthcare Provider Details

I. General information

NPI: 1982709531
Provider Name (Legal Business Name): REESHAD RUSI BUHARIWALLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 CONNEAUT AVE STE 206
BOWLING GREEN OH
43402-5300
US

IV. Provider business mailing address

745 HASKINS RD STE B
BOWLING GREEN OH
43402-1600
US

V. Phone/Fax

Practice location:
  • Phone: 419-353-6225
  • Fax: 419-354-0922
Mailing address:
  • Phone: 419-373-7607
  • Fax: 419-353-7076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-06-8953
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: