Healthcare Provider Details

I. General information

NPI: 1457308736
Provider Name (Legal Business Name): AHMED BILAL BUKSH DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2553 S KELLY AVE SUITE 100
EDMOND OK
73013-3888
US

IV. Provider business mailing address

2553 S KELLY AVE SUITE 100
EDMOND OK
73013-3888
US

V. Phone/Fax

Practice location:
  • Phone: 405-285-7408
  • Fax: 405-340-7077
Mailing address:
  • Phone: 405-285-7408
  • Fax: 405-340-7077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number199
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: