Shores Rheumatology PC

Primary specialty

Rheumatology PhysicianTaxonomy code 207RR0500X

License

AS048976 Issued in MI

Legal business name

SHORES RHEUMATOLOGY PC

Practice address

29200 Harper Ave
Saint Clair Shores, MI 48081-1274

Phone

(586) 777-7577

Fax

(586) 777-6841

NPI assigned

Apr 30, 2007

Organization subpart

No

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

Authorized official

Name

Andrew Sulich, MDNPI 1508946385

Title

President

Phone

(586) 777-7577

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Andrew J Sulich, MD

  • Rheumatology Physician
  • Saint Clair Shores, MI
  • NPI 1508946385
  Medicare reassignment Care Compare group NPD Authorized official
• Alissa Lumetta, FNP-BC

  • Family Nurse Practitioner
  • Detroit, MI
  • NPI 1457920126
  Medicare reassignment Care Compare group NPD
• Amar Q Majjhoo, MD

  • Rheumatology Physician
  • Saint Clair Shores, MI
  • NPI 1255411039
  Medicare reassignment Care Compare group NPD
• Rebecca Wideman, FNP-C

  • Family Nurse Practitioner
  • Saint Clair Shores, MI
  • NPI 1720438401
  Medicare reassignment Care Compare group NPD
• Daric Alexander Mueller, PA-C

  • Physician Assistant
  • Saint Clair Shores, MI
  • NPI 1578113171
  Medicare reassignment Care Compare group
• Maria Chakkalamuriyil Mathew

  • Medical Physician Assistant
  • Doylestown, PA
  • NPI 1508681222

  MI

  Medicare reassignment Care Compare group
• Susan J Vandellen, D.O.

  • Rheumatology Physician
  • Port Huron, MI
  • NPI 1598767394
  NPD (past)

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

{
    "created_epoch": "1177891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701388800000",
    "number": "1497975510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29200 HARPER AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480811274",
            "telephone_number": "586-362-2429",
            "fax_number": "586-777-6841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29200 HARPER AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480811274",
            "telephone_number": "586-777-7577",
            "fax_number": "586-777-6841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORES RHEUMATOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-30",
        "last_updated": "2023-12-01",
        "certification_date": "2023-12-01",
        "status": "A",
        "authorized_official_last_name": "SULICH",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "586-777-7577",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": "MI",
            "license": "AS048976",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2594326",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Shout It Out Speech and Language Therapy

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2023; 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.