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General NPI Number Information
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NPI Number | 1982709531
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Entity Type | Individual
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Provider Name | REESHAD RUSI BUHARIWALLA M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 06/15/2022
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Provider Practice Location Address
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Address Line | 1037 CONNEAUT AVE STE 206
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City | BOWLING GREEN
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State | OH
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Zip | 43402-5300
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Country | US
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Telephone | 419-353-6225
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Fax | 419-354-0922
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Provider Business Mailing Address
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Address Line | 745 HASKINS RD STE B
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City | BOWLING GREEN
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State | OH
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Zip | 43402-1600
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Country | US
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Telephone | 419-373-7607
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Fax | 419-353-7076
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35-06-8953
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License Number State | OH
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