Healthcare Provider Details

I. General information

NPI: 1972550028
Provider Name (Legal Business Name): SHAN MEDICAL EQUIPMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35818 DEQUINDRE RD
STERLING HTS MI
48310-4290
US

IV. Provider business mailing address

35818 DEQUINDRE RD
STERLING HTS MI
48310-4290
US

V. Phone/Fax

Practice location:
  • Phone: 586-268-4100
  • Fax: 586-268-4746
Mailing address:
  • Phone: 586-268-4100
  • Fax: 586-268-4746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number540E00688
License Number StateMI

VIII. Authorized Official

Name: ALI AL-KHAFAJI
Title or Position: PRESIDENT
Credential:
Phone: 586-268-4100