Healthcare Provider Details

I. General information

NPI: 1477562841
Provider Name (Legal Business Name): NASREEN BUKHARI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 NE 13TH ST 175
OKLAHOMA CITY OK
73104-5007
US

IV. Provider business mailing address

14916 SALEM CREEK RD
EDMOND OK
73013-2452
US

V. Phone/Fax

Practice location:
  • Phone: 405-270-0501
  • Fax: 405-290-1607
Mailing address:
  • Phone: 405-270-0501
  • Fax: 405-290-1607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number19975
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: