Provider Demographics
NPI:1053630319
Name:FAYEZ SHUKAIRY MD PC
Entity Type:Organization
Organization Name:FAYEZ SHUKAIRY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:248-887-6997
Mailing Address - Street 1:1050 S MILFORD RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HIGHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48357-4878
Mailing Address - Country:US
Mailing Address - Phone:248-887-6997
Mailing Address - Fax:248-889-2696
Practice Address - Street 1:1050 S MILFORD RD
Practice Address - Street 2:SUITE 105
Practice Address - City:HIGHLAND
Practice Address - State:MI
Practice Address - Zip Code:48357-4878
Practice Address - Country:US
Practice Address - Phone:248-887-6997
Practice Address - Fax:248-889-2696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2115509Medicaid
MI2115509Medicaid
A73279Medicare UPIN