Healthcare Provider Details

I. General information

NPI: 1396211611
Provider Name (Legal Business Name): BUKHARI PSYCHIATRIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 OLD NEWMAN RD STE 402
FRISCO TX
75036-8184
US

IV. Provider business mailing address

3341 REGENT BLVD STE 130 #383
IRVING TX
75063-3132
US

V. Phone/Fax

Practice location:
  • Phone: 817-900-2766
  • Fax: 817-898-7402
Mailing address:
  • Phone: 903-331-0506
  • Fax: 903-331-0462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SYED MUHAMMAD ALI IMRAN BUKHARI
Title or Position: MEDICAL DOCTOR/OWNER
Credential: MD
Phone: 347-545-9902