Provider Demographics
NPI:1811312366
Name:SHORES PODIATRY ASSOCIATES, P.C.
Entity type:Organization
Organization Name:SHORES PODIATRY ASSOCIATES, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-772-3500
Mailing Address - Street 1:20905 E 12 MILE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-6501
Mailing Address - Country:US
Mailing Address - Phone:586-541-7060
Mailing Address - Fax:586-541-3003
Practice Address - Street 1:20905 E 12 MILE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-6501
Practice Address - Country:US
Practice Address - Phone:586-541-7060
Practice Address - Fax:586-541-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-20
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy