Provider Demographics
NPI:1447204151
Name:SHORES PODIATRY ASSOCIATES, P.C.
Entity type:Organization
Organization Name:SHORES PODIATRY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-772-3500
Mailing Address - Street 1:20905 E 12 MILE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-6501
Mailing Address - Country:US
Mailing Address - Phone:586-772-3500
Mailing Address - Fax:586-772-6540
Practice Address - Street 1:20905 E 12 MILE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-6501
Practice Address - Country:US
Practice Address - Phone:586-772-3500
Practice Address - Fax:586-772-6540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E07641OtherBCBS
MICE4140OtherRAILROAD MEDICARE
MICE4140OtherRAILROAD MEDICARE
MI0551930001Medicare NSC