Provider Demographics
NPI:1437295789
Name:SHORES PSYCHIATRIC ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:SHORES PSYCHIATRIC ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-774-5050
Mailing Address - Street 1:24001 GREATER MACK AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1471
Mailing Address - Country:US
Mailing Address - Phone:586-774-5050
Mailing Address - Fax:586-774-1808
Practice Address - Street 1:24001 GREATER MACK AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1471
Practice Address - Country:US
Practice Address - Phone:586-774-5050
Practice Address - Fax:586-774-1808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0E047170-261Medicare ID - Type Unspecified