# MICHIGAN MEDICAL DIAGNOSTIC CENTER PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093941908
- **Authorized official:** DR. SHAHROKH MANSOORI M.D. (OWNER)
- **Authorized official phone:** (248) 844-2980

## Contact information

- **Practice address:** 135 BARCLAY CIR, SUITE 109, ROCHESTER HILLS, MI 48307-4599
- **Practice address phone:** (248) 844-2980
- **Practice address fax:** (248) 844-2983
- **Mailing address:** 135 BARCLAY CIR, SUITE 109, ROCHESTER HILLS, MI 48307-4599
- **Mailing address phone:** (248) 844-2980
- **Mailing address fax:** (248) 844-2983

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | AM076045 | MI | — |
| 207R00000X | Internal Medicine Physician | NM074148 | MI | — |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | SM038518 | MI | Yes |

## Other

- **Enumeration date:** 06/05/2009
- **Last updated:** 01/09/2012