Provider Demographics
NPI:1780943266
Name:ENDOCRINE SHORES PC
Entity type:Organization
Organization Name:ENDOCRINE SHORES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMOUDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-778-4950
Mailing Address - Street 1:PO BOX 250624
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025-0624
Mailing Address - Country:US
Mailing Address - Phone:586-778-4950
Mailing Address - Fax:
Practice Address - Street 1:18263 E 10 MILE RD STE D
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-5805
Practice Address - Country:US
Practice Address - Phone:586-778-4950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1265559488OtherNPI
MI4301083021OtherST LICENCE
MIFH0194225OtherDEA
MI4301083021OtherST LICENCE