Healthcare Provider Details

I. General information

NPI: 1316905003
Provider Name (Legal Business Name): SYED AZIM BUKHARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1073 HARDING MEMORIAL PKWY SUITE A
MARION OH
43302-6363
US

IV. Provider business mailing address

L-3549
COLUMBUS OH
43260-0001
US

V. Phone/Fax

Practice location:
  • Phone: 740-383-8579
  • Fax: 740-387-5244
Mailing address:
  • Phone: 740-383-7927
  • Fax: 740-383-7942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35042809B
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.042809
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: