Provider Demographics
NPI:1558876474
Name:MIDAN MEDICAL HOLDINGS PLLC
Entity Type:Organization
Organization Name:MIDAN MEDICAL HOLDINGS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:FAYEZ
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUKAIRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-691-7738
Mailing Address - Street 1:1501 S CENTER RD UNIT 3
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1731
Mailing Address - Country:US
Mailing Address - Phone:810-780-4181
Mailing Address - Fax:810-519-4842
Practice Address - Street 1:2786 E HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:MI
Practice Address - Zip Code:48356-2728
Practice Address - Country:US
Practice Address - Phone:810-875-3713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care