Healthcare Provider Details

I. General information

NPI: 1326030370
Provider Name (Legal Business Name): FAYEZ SHUKAIRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
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 TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036164724
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number037380
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: