Provider Demographics
NPI:1023280542
Name:DOUGLAS SHORE & SYLVIA VOELKER PTRS
Entity type:Organization
Organization Name:DOUGLAS SHORE & SYLVIA VOELKER PTRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:VOELKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:586-791-6060
Mailing Address - Street 1:34605 HARPER AVENUE
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035
Mailing Address - Country:US
Mailing Address - Phone:586-791-6060
Mailing Address - Fax:586-781-8211
Practice Address - Street 1:34605 HARPER AVENUE
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035
Practice Address - Country:US
Practice Address - Phone:586-791-6060
Practice Address - Fax:586-781-8211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISV002816103T00000X
MIDS003925103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIS48545Medicare UPIN