MEDICARE: FAISAL BUKHARI MD SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036088652	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110242003	OTHER	IL	PALMETTO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	07021960	OTHER	IL	BCBS ILLINOIS

General Provider Information

NPI Number	:	1376545509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAISAL BUKHARI MD SC

Provider Business Mailing Address
First Line	:	2 WEST ADAMS
Second Line	:
City	:	SULLIVAN
State	:	IL
Zip	:	61951-1983
Country	:	US
Telephone Number	:	217-728-7353
Fax Number	:	217-728-2580

Provider Business Practice Location Address
First Line	:	2 W ADAMS ST
Second Line	:
City	:	SULLIVAN
State	:	IL
Zip	:	61951-1943
Country	:	US
Telephone Number	:	217-728-7353
Fax Number	:	217-728-2580

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	04/29/2024

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Directions to “ FAISAL BUKHARI MD SC” Practice Location

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