Shores Medical Associates PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

CK008071 Issued in MI

Legal business name

SHORES MEDICAL ASSOCIATES PLLC

Practice address

25200 Little Mack Ave
Saint Clair Shores, MI 48081-2116

Phone

(586) 774-8720

Fax

(586) 774-7154

NPI assigned

May 20, 2008

Last updated

May 20, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Arnold Edwin Ketels

Title

Cfo

Phone

(586) 774-8720

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1211241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211241600000",
    "number": "1316104094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25200 LITTLE MACK AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480812116",
            "telephone_number": "586-774-8720",
            "fax_number": "586-774-7154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25200 LITTLE MACK AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480812116",
            "telephone_number": "586-774-8720",
            "fax_number": "586-774-7154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORES MEDICAL ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-20",
        "last_updated": "2008-05-20",
        "status": "A",
        "authorized_official_last_name": "KETELS",
        "authorized_official_first_name": "ARNOLD",
        "authorized_official_middle_name": "EDWIN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "586-774-8720",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "CK008071",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Saint Clair Shores, MI
• Providers in Saint Clair Shores, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.