# ST CLAIRE SHORES MEDICAL PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316194640
- **Authorized official:** DR. BERNARD W SHELTON M.D. (SOLE PROPRIETOR)
- **Authorized official phone:** (586) 293-1868

## Contact information

- **Practice address:** 30140 HARPER AVE, SUITE 300, SAINT CLAIR SHORES, MI 48082-1610
- **Practice address phone:** (586) 293-1848
- **Practice address fax:** (586) 293-1869
- **Mailing address:** 30140 HARPER AVE, SUITE 300, SAINT CLAIR SHORES, MI 48082-1610
- **Mailing address phone:** (586) 293-1848
- **Mailing address fax:** (586) 293-1869

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 4301088798 | MI | Yes |

## Other

- **Enumeration date:** 08/18/2008
- **Last updated:** 10/08/2014

## 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 |