Provider Demographics
NPI:1629110804
Name:SHORES PRIMARY CARE, P.C.
Entity Type:Organization
Organization Name:SHORES PRIMARY CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:Y
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-772-7180
Mailing Address - Street 1:28001 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1561
Mailing Address - Country:US
Mailing Address - Phone:586-772-7180
Mailing Address - Fax:586-279-0033
Practice Address - Street 1:28001 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1561
Practice Address - Country:US
Practice Address - Phone:586-772-7180
Practice Address - Fax:586-279-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N67900OtherHAP,OUT OF NETWORK
MIE83365OtherHEALTH CHOICE HAP
MI4541715Medicaid
MI022739OtherMIDWEST HEALTH PLAN
MI107599PCOtherCARE CHOICES
MI4541715OtherMOLINA HEALTH CARE OF MI
MI0004122882OtherAETNA
MI022739OtherMIDWEST MEDICARE ADVANTAG
MI141770OtherGREAT LAKES HEALTH PLAN
MIE83365OtherHEALTH ALLIANCE PLAN
MI700EO0079-0OtherBLUE CROSS BLUE SHIELD
MI4541715Medicaid
MIE83365Medicare UPIN