Basic Information
| Provider Information | |||||||||
| NPI: | 1255316295 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHUKRI | ||||||||
| FirstName: | ASFANDIAR | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 S BALLENGER HWY | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103421000 | ||||||||
| FaxNumber: | 8103421590 | ||||||||
| Practice Location | |||||||||
| Address1: | 1459 S CENTER RD | ||||||||
| Address2: | |||||||||
| City: | BURTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485091726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8104960900 | ||||||||
| FaxNumber: | 8107423891 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2005 | ||||||||
| LastUpdateDate: | 05/20/2008 | ||||||||
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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 | 208D00000X | 4301044126 | MI | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 080D410020 | 01 | MI | COMMUNITY BLUE PPO | OTHER | AS044126 | 01 | MI | BCBS | OTHER | 104172498 | 05 | MI | MEDICAID | 201895 | 01 | MI | HEALTH ADVANTAGE NETWORK | OTHER | 080D410020 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 0984529 | 01 | MI | HEALTH PLUS | OTHER | B49445 | 01 | MI | HAP | OTHER | 4688388 | 05 | MI | MEDICAID | 3497004 | 05 | MI | MEDICAID | 700B511870 | 01 | MI | BLUE CARE NETWORK | OTHER | 201895 | 01 | MI | MCLAREN HEALTH PLAN | OTHER |