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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