Provider Demographics
NPI:1255316295
Name:SHUKRI, ASFANDIAR A (MD)
Entity Type:Individual
Prefix:
First Name:ASFANDIAR
Middle Name:A
Last Name:SHUKRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-1000
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:1459 S CENTER RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1726
Practice Address - Country:US
Practice Address - Phone:810-496-0900
Practice Address - Fax:810-742-3891
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044126208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080D410020OtherCOMMUNITY BLUE PPO
MIAS044126OtherBCBS
MI104172498Medicaid
MI201895OtherHEALTH ADVANTAGE NETWORK
MI080D410020OtherBLUE CROSS BLUE SHIELD
MI0984529OtherHEALTH PLUS
MIB49445OtherHAP
MI4688388Medicaid
MI3497004Medicaid
MI700B511870OtherBLUE CARE NETWORK
MI201895OtherMCLAREN HEALTH PLAN
MI0M92460010Medicare PIN
MIAS044126OtherBCBS
MI700B511870OtherBLUE CARE NETWORK
MI3497004Medicaid