MEDICARE: DR. ALI SHUKR 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	207R00000X	Internal Medicine Physician	4301103702	MI

General Provider Information

NPI Number	:	1629418777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALI SHUKR M.D.

Provider Business Mailing Address
First Line	:	7319 OAKMAN BLVD
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-1526
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	32600 JOHN R RD
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-1338
Country	:	US
Telephone Number	:	248-307-7796
Fax Number	:	248-307-7801

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

Provider Enumeration Date	:	07/02/2013
Last Update Date	:	12/14/2020

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