Healthcare Provider Details

I. General information

NPI: 1629110804
Provider Name (Legal Business Name): SHORES PRIMARY CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28001 HARPER AVE
SAINT CLAIR SHORES MI
48081-1561
US

IV. Provider business mailing address

28001 HARPER AVE
SAINT CLAIR SHORES MI
48081-1561
US

V. Phone/Fax

Practice location:
  • Phone: 586-772-7180
  • Fax: 586-279-0033
Mailing address:
  • Phone: 586-772-7180
  • Fax: 586-279-0033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number StateMI

VIII. Authorized Official

Name: RONALD Y BARNETT
Title or Position: OWNER
Credential: DO
Phone: 586-772-7180