# MICHIGANS PREMIER FOOT AND ANKLE PLLC

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

## Provider details

- **NPI number:** 1962045161
- **Authorized official:** ALAA MANSOUR DPM (SOLE MEMBER)
- **Authorized official phone:** (630) 808-9939

## Contact information

- **Practice address:** 17000 EXECUTIVE PLAZA DR STE 101, DEARBORN, MI 48126-2793
- **Practice address phone:** (313) 565-4948
- **Practice address fax:** (313) 565-4989
- **Mailing address:** 5861 DEEPWOOD CT, CLARKSTON, MI 48346-3168

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | Yes |

## Other

- **Enumeration date:** 10/21/2019
- **Last updated:** 10/21/2019