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Organization
ST CLAIRE SHORES MEDICAL PLLC
Active
Organization
ST CLAIRE SHORES MEDICAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BERNARD W SHELTON M.D. (SOLE PROPRIETOR)
(586) 293-1868
Entity
Organization
Contact information
Practice address
30140 HARPER AVE, SUITE 300, SAINT CLAIR SHORES, MI 48082-1610
(586) 293-1848
(586) 293-1869
Mailing address
30140 HARPER AVE, SUITE 300, SAINT CLAIR SHORES, MI 48082-1610
(586) 293-1848
(586) 293-1869
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
4301088798
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0502329
BCBS
MI
01
—
1417032491
NPI
MI
05
—
4945780-10
—
MI
01
—
70-0-F32947-0
BCBS CPIN#
MI
Enumeration date
08/18/2008
Last updated
10/08/2014
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