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General NPI Number Information
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NPI Number | 1811312366
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Entity Type | Organization
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Legal Business Name | SHORES PODIATRY ASSOCIATES, P.C.
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Dates
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Enumeration Date | 02/20/2014
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Last Update Date | 04/18/2014
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Provider Practice Location Address
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Address Line | 20905 E 12 MILE RD SUITE 300
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City | ROSEVILLE
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State | MI
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Zip | 48066-6501
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Country | US
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Telephone | 586-541-7060
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Fax | 586-541-3003
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Provider Business Mailing Address
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Address Line | 20905 E 12 MILE RD SUITE 300
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City | ROSEVILLE
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State | MI
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Zip | 48066-6501
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Country | US
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Telephone | 586-541-7060
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Fax | 586-541-3003
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DANIA DESMITH
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Credential |
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Telephone | 586-772-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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