MEDICARE: SHORES RHEUMATOLOGY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	AM72302	MI

General Provider Information

NPI Number	:	1649490772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHORES RHEUMATOLOGY PC

Provider Business Mailing Address
First Line	:	24100 LITTLE MACK AVE
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48080-3247
Country	:	US
Telephone Number	:	586-777-7577
Fax Number	:	586-777-6841

Provider Business Practice Location Address
First Line	:	24100 LITTLE MACK AVE
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48080-3247
Country	:	US
Telephone Number	:	586-777-7577
Fax Number	:	586-777-6841

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	AMAR MAJJHOO
Credential	:	MD
Telephone Number	:	586-777-7577

Provider Enumeration Date	:	04/30/2007
Last Update Date	:	08/22/2020

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