Healthcare Provider Details

I. General information

NPI: 1366098550
Provider Name (Legal Business Name): MIDAN MEDICAL HOLDINGS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2786 E HIGHLAND RD
HIGHLAND MI
48356-2728
US

IV. Provider business mailing address

2786 E HIGHLAND RD
HIGHLAND MI
48356-2728
US

V. Phone/Fax

Practice location:
  • Phone: 248-887-7877
  • Fax: 248-887-7522
Mailing address:
  • Phone: 248-887-7877
  • Fax: 248-887-7522

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 Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: FAYEZ SHUKAIRY
Title or Position: OWNER
Credential: MD
Phone: 248-887-7877