NPIMap

Organization Active NPI

Khaled M Shukairy MD PC

  • Otolaryngology/Facial Plastic Surgery Physician
  • Burton, MI
National Provider Identifier
1386830651
Registry record updated Nov 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X
License
4301037118 Issued in MI
Legal business name
KHALED M SHUKAIRY MD PC
Practice address
1501 S Center Rd
BLDG B
Burton, MI 48509-1731
Phone
(810) 742-0225
Fax
(810) 742-7990
NPI assigned
Sep 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Khaled M Shukairy, MDNPI 1518961879
Title
President/Owner
Phone
(810) 742-0225

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology/Facial Plastic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207YX0905X 4301037118 MI Primary

Addresses

Primary practice location

1501 S Center Rd
BLDG B
Burton, MI 48509-1731

Mailing address

1501 S Center Rd
BLDG B
Burton, MI 48509-1731
Phone (810) 742-0225

Other identifiers 1

IdentifierTypeStateIssuer
2126594MedicaidMI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258934400000",
    "number": "1386830651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 S CENTER RD",
            "address_2": "BLDG B",
            "city": "BURTON",
            "state": "MI",
            "postal_code": "485091731",
            "telephone_number": "810-742-0225",
            "fax_number": "810-742-7990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 S CENTER RD",
            "address_2": "BLDG B",
            "city": "BURTON",
            "state": "MI",
            "postal_code": "485091731",
            "telephone_number": "810-742-0225",
            "fax_number": "810-742-7990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KHALED M SHUKAIRY MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-20",
        "last_updated": "2009-11-23",
        "status": "A",
        "authorized_official_last_name": "SHUKAIRY",
        "authorized_official_first_name": "KHALED",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "810-742-0225",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207YX0905X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "MI",
            "license": "4301037118",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2126594",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burton, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.