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425 Old Newman Rd Ste 402 Frisco TX 75036-8184 | |
| (817) 900-2766 | |
| (817) 898-7402 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 425 Old Newman Rd Ste 402, Frisco, Texas |
| Authorized Official Name and Position | Syed Muhammad Ali Imran Bukhari (MEDICAL DOCTOR/OWNER) |
| Authorized Official Contact | 3475459902 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3341 Regent Blvd Ste 130 #383 Irving TX 75063-3132 Ph: (903) 331-0506 | 425 Old Newman Rd Ste 402 Frisco TX 75036-8184 Ph: (817) 900-2766 |
| NPI Number | 1396211611 |
|---|---|
| Provider Enumeration Date | 10/15/2018 |
| Last Update Date | 11/22/2022 |
| Certification Date | 11/22/2022 |
| Medicare PECOS PAC ID | 8921348053 |
|---|---|
| Medicare Enrollment ID | O20190327001341 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396211611 | NPI | - | NPPES |
| 394698001 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Ngozi E Okam |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740760453 PECOS PAC ID: 4880934041 Enrollment ID: I20190326000777 |
| Provider Name | Syed Muhammad Ali Imran Bukhari |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013265677 PECOS PAC ID: 8527372903 Enrollment ID: I20190327002524 |
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