NPIMap

Organization Active NPI

Shores Diagnostic LLC

Doing business as Shores Diagnostic Pllc

  • Radiology Clinic/Center
  • Warren, MI
National Provider Identifier
1235110289
Registry record updated Mar 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
SHORES DIAGNOSTIC LLC
Doing business as
Shores Diagnostic Pllc
The CT Center
Practice address
29230 Ryan Rd Ste C-1
Warren, MI 48092-4274
Phone
(313) 285-8728
Fax
(313) 784-9055
NPI assigned
Nov 8, 2005
Last updated
Mar 25, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gulam Mohiuddin
Title
President
Phone
(313) 285-8728

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X Primary

Addresses

Primary practice location

29230 Ryan Rd Ste C-1
Warren, MI 48092-4274

Mailing address

29230 Ryan Rd Ste C-1
Warren, MI 48092-4274
Phone (313) 285-8728

Other identifiers 4

IdentifierTypeStateIssuer
104763580MedicaidMI
310E017130OtherMIBCBS OF MICHIGAN
114769270MedicaidMI
104763590MedicaidMI

Other names 2

  • Shores Diagnostic Pllc Doing business as
  • The CT Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051014000508 MI Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 7416973813 Practice locations: Warren, MI

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742860800000",
    "number": "1235110289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29230 RYAN RD STE C-1",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480924274",
            "telephone_number": "313-285-8728",
            "fax_number": "313-784-9055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29230 RYAN RD STE C-1",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480924274",
            "telephone_number": "313-285-8728",
            "fax_number": "313-784-9055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORES DIAGNOSTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-08",
        "last_updated": "2025-03-25",
        "certification_date": "2025-03-25",
        "status": "A",
        "authorized_official_last_name": "MOHIUDDIN",
        "authorized_official_first_name": "GULAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "313-285-8728"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104763580",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MICHIGAN",
            "identifier": "310E017130",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114769270",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104763590",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shores Diagnostic Pllc",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The CT Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Warren, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.