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General NPI Number Information
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NPI Number | 1144511312
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Entity Type | Organization
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Legal Business Name | GENESEE ENT ASSOCIATES, PC
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Dates
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Enumeration Date | 04/22/2011
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Last Update Date | 04/22/2011
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Provider Practice Location Address
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Address Line | 1501 S CENTER RD BLDG B
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City | BURTON
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State | MI
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Zip | 48509-1731
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Country | US
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Telephone | 810-742-0225
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Fax | 810-742-7990
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Provider Business Mailing Address
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Address Line | 1501 S CENTER RD BLDG B
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City | BURTON
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State | MI
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Zip | 48509-1731
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Country | US
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Telephone | 810-742-0225
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Fax | 810-742-7990
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. KHALED SHUKAIRY
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Credential | M.D.
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Telephone | 810-742-0225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number | 1601000320
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License Number State | MI
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