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General NPI Number Information
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NPI Number | 1366098550
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Entity Type | Organization
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Legal Business Name | MIDAN MEDICAL HOLDINGS PLLC
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Dates
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Enumeration Date | 08/13/2019
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Last Update Date | 08/13/2019
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Provider Practice Location Address
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Address Line | 2786 E HIGHLAND RD
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City | HIGHLAND
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State | MI
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Zip | 48356-2728
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Country | US
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Telephone | 248-887-7877
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Fax | 248-887-7522
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Provider Business Mailing Address
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Address Line | 2786 E HIGHLAND RD
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City | HIGHLAND
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State | MI
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Zip | 48356-2728
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Country | US
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Telephone | 248-887-7877
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Fax | 248-887-7522
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Authorized Official
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Title or Position | OWNER
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Name | FAYEZ SHUKAIRY
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Credential | MD
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Telephone | 248-887-7877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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