Organization
SHORES DIAGNOSTIC LLC
Active
Other names
The CT Center, Shores Diagnostic Pllc
Organization subpart
No
Provider details
NPI number
Authorized official
GULAM MOHIUDDIN (PRESIDENT)
(313) 285-8728
Entity
Organization
Contact information
Practice address
29230 RYAN RD STE C-1, WARREN, MI 48092-4274
(313) 285-8728
(313) 784-9055
Mailing address
29230 RYAN RD STE C-1, WARREN, MI 48092-4274
(313) 285-8728
(313) 784-9055
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104763580
—
MI
05
—
104763590
—
MI
05
—
114769270
—
MI
01
—
310E017130
BCBS OF MICHIGAN
MI
Enumeration date
11/08/2005
Last updated
03/25/2025
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