Basic Information
| Provider Information | |||||||||
| NPI: | 1578764551 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHKOUKANI | ||||||||
| FirstName: | MAHDI | ||||||||
| MiddleName: | ABDELATIF | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M,D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1420 STEPHENSON HWY | ||||||||
| Address2: | SUITE 400-CREDENTIALING | ||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480831189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485815974 | ||||||||
| FaxNumber: | 2485815640 | ||||||||
| Practice Location | |||||||||
| Address1: | 18101 OAKWOOD BLVD | ||||||||
| Address2: | SUITE 402 | ||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481244089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132530800 | ||||||||
| FaxNumber: | 3135778555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2007 | ||||||||
| LastUpdateDate: | 11/06/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0122X | 4301086194 | MI | N | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery | 207Y00000X | 4301086194 | MI | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.