NPIMap

Organization Active NPI

Genesee ENT Associates PC

  • Plastic Surgery within the Head & Neck (Otolaryngology) Physician
  • Burton, MI
National Provider Identifier
1992032338
Registry record updated Feb 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery within the Head & Neck (Otolaryngology) PhysicianTaxonomy code 207YX0007X
License
4301037118 Issued in MI
Legal business name
GENESEE ENT ASSOCIATES PC
Practice address
1501 S Center Rd
BLDG B
Burton, MI 48509-1731
Phone
(810) 742-0225
Fax
(810) 742-7990
NPI assigned
Nov 5, 2009
Last updated
Feb 16, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2011

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

Authorized official

Name
Dr. Khaled M Shukairy, MDNPI 1518961879
Title
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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Sleep Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RS0012X 4301085139 MI
Plastic Surgery within the Head & Neck (Otolaryngology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207YX0007X 4301037118 MI Primary
Audiologist-Hearing Aid FitterGroup: 193200000X MULTI-SPECIALTY GROUP 237600000X 1601000320 MI

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100120000567 MI Part B Supplier - Clinic/Group Practice 1153463765 Receives reassigned benefits from 5 practitioners
Practice locations: Burton, MI

National Provider Directory

National Provider Directory

Locations

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

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

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1257379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297814400000",
    "number": "1992032338",
    "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": "GENESEE ENT ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-05",
        "last_updated": "2011-02-16",
        "status": "A",
        "authorized_official_last_name": "SHUKAIRY",
        "authorized_official_first_name": "KHALED",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "810-742-0225",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RS0012X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "MI",
            "license": "4301085139",
            "primary": false
        },
        {
            "code": "207YX0007X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": "MI",
            "license": "4301037118",
            "primary": true
        },
        {
            "code": "237600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "MI",
            "license": "1601000320",
            "primary": false
        }
    ],
    "identifiers": [],
    "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 Feb 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.