Provider Demographics
NPI:1215249594
Name:METRO SHORES INTERNAL MEDICINE, PLLC
Entity type:Organization
Organization Name:METRO SHORES INTERNAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:JANESKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-479-8800
Mailing Address - Street 1:18580 FORT STREET
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-7442
Mailing Address - Country:US
Mailing Address - Phone:734-479-8800
Mailing Address - Fax:734-283-4861
Practice Address - Street 1:18580 FORT ST
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-7442
Practice Address - Country:US
Practice Address - Phone:734-479-8800
Practice Address - Fax:734-283-4861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-02
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty