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General NPI Number Information
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NPI Number | 1235110289
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Entity Type | Organization
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Legal Business Name | SHORES DIAGNOSTIC LLC
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Dates
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Enumeration Date | 11/08/2005
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 29230 RYAN RD STE C-1
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City | WARREN
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State | MI
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Zip | 48092-4274
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Country | US
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Telephone | 313-285-8728
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Fax | 313-784-9055
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Provider Business Mailing Address
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Address Line | 29230 RYAN RD STE C-1
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City | WARREN
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State | MI
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Zip | 48092-4274
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Country | US
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Telephone | 313-285-8728
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Fax | 313-784-9055
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Authorized Official
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Title or Position | PRESIDENT
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Name | GULAM MOHIUDDIN
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Credential |
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Telephone | 313-285-8728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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