Individual
SUPRIYA SHORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.B.B.S
Contact information
Practice address
7500 CHALLIS RD, 2ND FLOOR, BRIGHTON, MI 48116-9416
(810) 263-4000
Mailing address
3621 S STATE ST, ANN ARBOR, MI 48108-1633
(734) 647-5299
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301114850
MI
207R00000X
Internal Medicine Physician
52579
CO
207RA0001X
Advanced Heart Failure and Transplant Cardiology Physician
Primary
4301114850
MI
207RC0000X
Cardiovascular Disease Physician
4301114850
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
024175
KAISER COMMERCIAL NUMBET
CO
05
—
19509286
—
CO
Enumeration date
03/02/2012
Last updated
02/25/2020
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