Provider Demographics
NPI:1710065354
Name:ST CLAIR SHORES OBSTETRICS AND GYNECOLOGY, PLC
Entity Type:Organization
Organization Name:ST CLAIR SHORES OBSTETRICS AND GYNECOLOGY, PLC
Other - Org Name:
Other - Org Type:
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:
Practice Address - Street 1:46591 ROMEO PLANK RD
Practice Address - Street 2:SUITE 225
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-5742
Practice Address - Country:US
Practice Address - Phone:586-226-6155
Practice Address - Fax:586-226-6160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty