=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437738580
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SYED BUKHARI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2021
-----------------------------------------------------
Last Update Date | 05/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1150 E SHERMAN BLVD STE 1100
-----------------------------------------------------
City | MUSKEGON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49444-4607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-672-7800
-----------------------------------------------------
Fax | 231-672-7801
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14124 PATTERSON DR
-----------------------------------------------------
City | SHELBY TWP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48315-4263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 4301513482
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------