St Clair Shores Obstetrics and Gynecolgy, PLC
Organization Active NPI Obstetrics & Gynecology Physician · Saint Clair Shores, MI
NPI 1164535886 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1164535886
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- Legal business name
- ST CLAIR SHORES OBSTETRICS AND GYNECOLGY, PLC
- Practice address
- 19714 E 10 Mile Rd
Saint Clair Shores, MI 48080-1064 - Phone
- (586) 779-9400
- Fax
- (586) 779-8949
- NPI assigned
- Aug 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Constantine Raphtis, D.O.
- Title
- Member
- Phone
- (586) 779-9400
Corporate family (same tax ID) 1
Practitioners 9
-
Kami Michele Kveton, M.D.
-
Anne Marie B McCarren, M.D.
-
Constantine Raphtis, D.O.
-
Michelle Ann Konieczny, M.D.
-
Jennifer Kuzel, MD
-
Wontika R. Smith, M.D.
-
Mary Margaret Yenchick, M.D.
-
Pete Papapanos, M.D
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040914000287 | MI | Part B Supplier - Clinic/Group Practice | 9638146251 |
Receives reassigned benefits from 6 practitioners Practice locations: Macomb, MI; Saint Clair Shores, MI |
National Provider Directory
- Tax ID family
- Shores OBGYN
Locations
19714 E 10 Mile Rd
St Clr Shores, MI 48080
Phone (586) 779-9400
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician |
207V00000X | Yes |
Addresses
Primary practice location
19714 E 10 Mile Rd
Saint Clair Shores, MI 48080-1064
Mailing address
19714 Ten Mile Road
St Clair Shores, MI 48080
Phone (586) 779-9400
Other names
- Shores OB/GYN
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- St Clair Pharmacy LLC
- St Clair Shore Pharmacy Mi LLC
- St Clair Shores Hearing Center
- St Clair Shores Mi Ophthalmology ASC LLC
- St Clair Tooth Company PLLC
- St Clair Vascular Associates PC
- St Claire Shores Family Dental PLLC
- St Claire Shores Medical PLLC
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All providers in Saint Clair Shores, MI · Obstetrics & Gynecology Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.