Provider Demographics
NPI:1326030370
Name:SHUKAIRY, FAYEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:FAYEZ
Middle Name:
Last Name:SHUKAIRY
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 1:1050 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
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI037380208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2115509Medicaid
MI2115509Medicaid
MI06303945021Medicare ID - Type Unspecified