| Endocrine Shores Pc | |
|
18263 E 10 Mile Rd Ste D Roseville MI 48066-5805 | |
| (586) 778-4950 | |
| Not Available |
| Full Name | Endocrine Shores Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 18263 E 10 Mile Rd Ste D, Roseville, Michigan |
| Authorized Official Name and Position | Mohammad Hammoude (OWNER) |
| Authorized Official Contact | 5867784950 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Endocrine Shores Pc Po Box 250624 Franklin MI 48025-0624 Ph: (586) 778-4950 | Endocrine Shores Pc 18263 E 10 Mile Rd Ste D Roseville MI 48066-5805 Ph: (586) 778-4950 |
| NPI Number | 1780943266 |
|---|---|
| Provider Enumeration Date | 05/03/2012 |
| Last Update Date | 03/07/2023 |
| Medicare PECOS PAC ID | 3779739990 |
|---|---|
| Medicare Enrollment ID | O20120803000346 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780943266 | NPI | - | NPPES |
| 1265559488 | Other | MI | NPI |
| 4301083021 | Other | MI | ST LICENCE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Mohammad A Hammoude |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1265559488 PECOS PAC ID: 8426156472 Enrollment ID: I20070614000420 |
| Provider Name | Jeffrey Michael Kadzielewski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932465457 PECOS PAC ID: 8224359823 Enrollment ID: I20150608002645 |
| Provider Name | Desara Uldedaj |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457058273 PECOS PAC ID: 1850757832 Enrollment ID: I20230517001464 |
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