Organization
GENESEE ENT ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KHALED SHUKAIRY M.D. (OWNER/PRESIDENT)
(810) 742-0225
Entity
Organization
Contact information
Practice address
1501 S CENTER RD, BLDG B, BURTON, MI 48509-1731
(810) 742-0225
(810) 742-7990
Mailing address
1501 S CENTER RD, BLDG B, BURTON, MI 48509-1731
(810) 742-0225
(810) 742-7990
Taxonomy
Speciality
Code
Description
License number
State
332S00000X
Hearing Aid Equipment
Primary
1601000320
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1601000320
STATE OF MICHIGAN MI HEALTH PROF LICENSE
MI
05
—
805367063
—
MI
Enumeration date
04/22/2011
Last updated
04/22/2011
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