Provider Demographics
NPI:1164535886
Name:ST CLAIR SHORES OBSTETRICS AND GYNECOLGY, PLC
Entity Type:Organization
Organization Name:ST CLAIR SHORES OBSTETRICS AND GYNECOLGY, PLC
Other - Org Name:SHORES OB/GYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPHTIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-779-9400
Mailing Address - Street 1:19714 TEN MILE ROAD
Mailing Address - Street 2:
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080
Mailing Address - Country:US
Mailing Address - Phone:586-779-9400
Mailing Address - Fax:586-779-8949
Practice Address - Street 1:19714 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1064
Practice Address - Country:US
Practice Address - Phone:586-779-9400
Practice Address - Fax:586-779-8949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty