Healthcare Provider Details

I. General information

NPI: 1750677795
Provider Name (Legal Business Name): KARIM BOUKHEMIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 1ST AVE STE 400
HUNTINGTON WV
25702-1236
US

IV. Provider business mailing address

555 N ARLINGTON AVE
RENO NV
89503-4723
US

V. Phone/Fax

Practice location:
  • Phone: 304-525-6905
  • Fax:
Mailing address:
  • Phone: 775-786-3040
  • Fax: 775-786-1358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number17254
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberA-147018
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number24986
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: