Provider Demographics
NPI:1952651671
Name:SHUKR, MUSTAFA (MD)
Entity Type:Individual
Prefix:DR
First Name:MUSTAFA
Middle Name:
Last Name:SHUKR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30301 WOODWARD AVE STE 240
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-0982
Mailing Address - Country:US
Mailing Address - Phone:248-565-3700
Mailing Address - Fax:248-850-8921
Practice Address - Street 1:30301 WOODWARD AVE STE 240
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-0982
Practice Address - Country:US
Practice Address - Phone:248-565-3700
Practice Address - Fax:248-850-8921
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301101571208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine