MEDICARE: KAMAL C SHOUKRI MD

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	29390	CT
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	228390	MA

General Provider Information

NPI Number	:	1649277013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMAL C SHOUKRI MD

Provider Business Mailing Address
First Line	:	114 WOODLAND ST
Second Line	:	CENTER FOR DIABETES
City	:	HARTFORD
State	:	CT
Zip	:	06105-1208
Country	:	US
Telephone Number	:	860-714-4402
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 WOODLAND ST
Second Line	:	CENTER FOR DIABETES
City	:	HARTFORD
State	:	CT
Zip	:	06105-1208
Country	:	US
Telephone Number	:	860-714-4402
Fax Number	:

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	12/02/2015

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