MEDICARE: DR. FAYEZ SHUKAIRY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	036164724	IL
2	208600000X	Surgery Physician	037380	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326030370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FAYEZ SHUKAIRY M.D.

Provider Business Mailing Address
First Line	:	1050 S MILFORD RD
Second Line	:	SUITE 105
City	:	HIGHLAND
State	:	MI
Zip	:	48357-4878
Country	:	US
Telephone Number	:	248-887-6997
Fax Number	:	248-889-2696

Provider Business Practice Location Address
First Line	:	1050 S MILFORD RD
Second Line	:	SUITE 105
City	:	HIGHLAND
State	:	MI
Zip	:	48357-4878
Country	:	US
Telephone Number	:	248-887-6997
Fax Number	:	248-889-2696

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	09/13/2024

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