MEDICARE: DR. SHUKRI M.F. ELKHAIRI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	35-03-9731	OH

General Provider Information

NPI Number	:	1053311415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHUKRI M.F. ELKHAIRI M.D.

Provider Business Mailing Address
First Line	:	6100 ROCKSIDE WOODS BLVD
Second Line	:
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-2366
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12000 MCCRACKEN RD
Second Line	:	SUITE 214
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-2964
Country	:	US
Telephone Number	:	216-587-3422
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/10/2007

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