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Organization
MACOMB PRIMARY CARE PC
Active
Organization
MACOMB PRIMARY CARE PC
Active
Other names
Revolution Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
CHADI MANSOUR MD (PHYSICIAN)
(586) 323-0301
Entity
Organization
Contact information
Practice address
51850 DEQUINDRE RD STE 2, SHELBY TOWNSHIP, MI 48316-2806
(586) 323-0301
Mailing address
PO BOX 3272, SAGINAW, MI 48605-3272
(989) 797-1400
(989) 797-4077
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301077635
MI
Other
Enumeration date
12/16/2009
Last updated
09/17/2021
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