Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 4301037118 | MI |
NPI | 1518961879 |
---|---|
Provider Name | Dr. Khaled M Shukairy |
First Address | Burton, MI 48509-1731 |
Second Address | Burton, MI 48509-1731 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2005 |
Last Update Date | 16/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2126594 | (05) | MI |
B47600 | (02) |