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General NPI Number Information
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NPI Number | 1609140029
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Entity Type | Individual
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Provider Name | SUPRIYA SHORE M.B.B.S
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Gender | Female
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Dates
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Enumeration Date | 03/02/2012
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Last Update Date | 02/25/2020
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Provider Practice Location Address
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Address Line | 7500 CHALLIS RD 2ND FLOOR
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City | BRIGHTON
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State | MI
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Zip | 48116-9416
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Country | US
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Telephone | 810-263-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 3621 S STATE ST
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City | ANN ARBOR
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State | MI
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Zip | 48108-1633
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Country | US
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Telephone | 734-647-5299
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 52579
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301114850
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 4301114850
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 207RA0001X
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Taxonomy Name | Advanced Heart Failure and Transplant Cardiology Physician
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License Number | 4301114850
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License Number State | MI
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