SHORES MEDICAL ASSOCIATES PLLC (NPI# 1316104094) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316104094 |
| Entity Type | Organization |
| Organization Name | SHORES MEDICAL ASSOCIATES PLLC |
| Practice Address |
25200 Little Mack Ave Saint Clair Shores MI 48081-2116 |
| Practice Telephone | 5867748720 |
| Practice Fax Number | 5867747154 |
| Mailing Telephone | 5867748720 |
| Mailing Fax Number | 5867747154 |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2008-05-20 |
| Authorized Official Name | MR. ARNOLD EDWIN KETELS (CFO) |
| Authorized Official Telephone | 5867748720 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | CK008071 | MI | Allopathic & Osteopathic Physicians |
| Street Address |
25200 LITTLE MACK AVE |
| City | SAINT CLAIR SHORES |
| State | MI |
| Zip Code | 48081-2116 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053895193 | Ayesha Massey Bennett | Nurse Practitioner | 25200 Little Mack Ave, Saint Clair Shores, MI 48081-2116 | 2018-09-24 |
| 1053897496 | Meghan Martinovski | Nurse Practitioner | 25200 Little Mack Ave, Saint Clair Shores, MI 48081-2116 | 2018-07-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750865416 | Saint Clair Family Pharmacy LLC | Pharmacy | 28001 Harper Ave., Saint Clair Shores, MI 48081 | 2018-09-19 |
| 1669995783 | Terra Laquay Ginther | Social Worker | 28800 Harper Ave Ste A, Saint Clair Shores, MI 48081 | 2017-07-20 |
| 1245676998 | Julia Hanson | Social Worker | 27941 Harper Ave., Suite 105, St. Clair Shores, MI 48081 | 2013-05-21 |
| 1760731301 | Life Transition Service | Community/Behavioral Health | 21031 Sunnydale, St. Clair Shore, MI 48081 | 2012-08-29 |
| 1477868792 | William Burr Wood | Pharmacist | 21000 Twelve Milerd., St Clair Shores, MI 48081 | 2010-08-11 |
| 1508094350 | Dominic Anthony Garrisi | Anesthesiology | 21018 Bon Brae, St. Clair Shores, MI 48081 | 2009-06-30 |
| 1992947022 | Karen Ostrowski-thomas | Occupational Therapist | 22442 Bayview, St. Clair Shores, MI 48081 | 2009-04-06 |
| 1891979787 | Chirag Rachhadia | Physical Therapist | 29150 Harper Avenue, St. Clair Shores, MI 48081 | 2007-12-27 |
| 1598955114 | Donna Warner Manczak | Psychologist | 21400 E Eleven Mil Rd, St Clair Shores, MI 48081 | 2007-07-30 |
| 1467652347 | Sumit Narayanprasad Fogla | Family Medicine | 21400 E Eleven Mile Road, St. Clair Shores, MI 48081 | 2007-07-19 |
| Find all providers in zip 48081 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881928455 | Sailaja Datla Md Plc | Internal Medicine | 21519 Harper Ave Ste 108, Saint Clair Shores, MI 48080-2220 | 2009-09-29 |
| 1235251042 | Robbie H Taha | Internal Medicine | 25631 Little Mack Ave Ste 205, Saint Clair Shores, MI 48081-2108 | 2007-04-04 |
| 1356499800 | George S Afram | Internal Medicine | 29275 Harper Ave, Saint Clair Shores, MI 48081-1248 | 2007-01-08 |
| 1346397411 | Paavan P Railan | Internal Medicine | 26901 Harper Ave, Saint Clair Shores, MI 48081-1971 | 2007-01-04 |
| 1871688549 | Denise M Jabbour | Internal Medicine | 23715 Little Mack Ave, Suite 100, Saint Clair Shores, MI 48080-1181 | 2006-10-04 |
| 1831201821 | Eastside Internal Medicine PC | Internal Medicine | 28315 Harper Ave, Saint Clair Shores, MI 48081-1687 | 2006-08-31 |
| 1154434975 | Sailaja Datla | Internal Medicine | 24800 Harper Ave Ste 1, Saint Clair Shores, MI 48080-1292 | 2006-08-16 |
| 1902835168 | Vincent Colina Maribao | Internal Medicine | 29167 Jefferson Ave Ste 100, Saint Clair Shores, MI 48081-1331 | 2006-07-01 |
| 1063486736 | Demetrios Mermiges | Internal Medicine | 19611 E 8 Mile Rd, Saint Clair Shores, MI 48080-1655 | 2006-02-17 |
| 1376523233 | Maya Ashkenazi | Internal Medicine | 23003 Greater Mack Ave, Saint Clair Shores, MI 48080-1965 | 2006-01-18 |
| Find all providers in SAINT CLAIR SHORES | ||||
| City | SAINT CLAIR SHORES |
| Zip Code | 48081 |
Please comment or provide details below to improve the information on SHORES MEDICAL ASSOCIATES PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.