Healthcare Provider Details

I. General information

NPI: 1053630319
Provider Name (Legal Business Name): FAYEZ SHUKAIRY MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 S MILFORD RD SUITE 105
HIGHLAND MI
48357-4878
US

IV. Provider business mailing address

1050 S MILFORD RD SUITE 105
HIGHLAND MI
48357-4878
US

V. Phone/Fax

Practice location:
  • Phone: 248-887-6997
  • Fax: 248-889-2696
Mailing address:
  • Phone: 248-887-6997
  • Fax: 248-889-2696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JANET MARIE WRIGHT
Title or Position: MANAGER
Credential: CPC
Phone: 248-887-6997