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General NPI Number Information
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NPI Number | 1457525248
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Entity Type | Organization
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Legal Business Name | SHORES INTERNAL MEDICINE P.C.
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 11/21/2013
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Provider Practice Location Address
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Address Line | 4777 E OUTER DR
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City | DETROIT
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State | MI
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Zip | 48234-3241
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Country | US
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Telephone | 313-576-8778
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Fax |
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Provider Business Mailing Address
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Address Line | 43750 GARFIELD RD SUITE 207
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-1135
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MALAZ ALATASSI
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Credential | M.D.
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Telephone | 586-778-4950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number |
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License Number State | MI
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