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General NPI Number Information
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NPI Number | 1376079384
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Entity Type | Individual
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Provider Name | KOOTAYBAH ALSHEIKHLY M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 1210 MEDICAL ARTS BLVD STE 104A
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City | ANDERSON
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State | IN
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Zip | 46011-3461
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Country | US
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Telephone | 317-355-7220
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Fax |
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Provider Business Mailing Address
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Address Line | 50505 SCHOENHERR RD STE 320
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City | SHELBY TWP
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State | MI
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Zip | 48315-3141
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Country | US
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Telephone | 586-580-3062
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Fax | 586-580-3143
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4301501769
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 4301501769
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 01095659A
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License Number State | IN
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