Provider Demographics
NPI:1346217627
Name:SHUKER, ALA S (MD)
Entity Type:Individual
Prefix:
First Name:ALA
Middle Name:S
Last Name:SHUKER
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 1:37669 PEMBROKE AVE
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1050
Mailing Address - Country:US
Mailing Address - Phone:734-793-6500
Mailing Address - Fax:734-793-6501
Practice Address - Street 1:37669 PEMBROKE AVE
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1050
Practice Address - Country:US
Practice Address - Phone:734-793-6500
Practice Address - Fax:734-793-6501
Is Sole Proprietor?:No
Enumeration Date:2006-03-04
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068726207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4623033Medicaid
MI4623033Medicaid
H14890Medicare UPIN