Provider Demographics
NPI:1578764551
Name:SHKOUKANI, MAHDI ABDELATIF (M,D)
Entity Type:Individual
Prefix:DR
First Name:MAHDI
Middle Name:ABDELATIF
Last Name:SHKOUKANI
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Gender:M
Credentials:M,D
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Mailing Address - Street 1:1420 STEPHENSON HWY
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1189
Mailing Address - Country:US
Mailing Address - Phone:248-581-5974
Mailing Address - Fax:248-581-5640
Practice Address - Street 1:18101 OAKWOOD BLVD
Practice Address - Street 2:SUITE 402
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4089
Practice Address - Country:US
Practice Address - Phone:313-253-0800
Practice Address - Fax:313-577-8555
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2013-11-06
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Provider Licenses
StateLicense IDTaxonomies
MI43010861942086S0122X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P30630737Medicare PIN