Organization
PYRAMIDAL REHAB, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MANSOUR MIKY M.D. (PRESIDENT)
(906) 225-7740
Entity
Organization
Contact information
Practice address
1414 W FAIR AVE, SUITE 204, MARQUETTE, MI 49855-2675
(906) 225-7740
Mailing address
2837 US HIGHWAY 41 W, MARQUETTE, MI 49855-2252
(906) 225-3964
(906) 226-3875
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
4301082652
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104603246
—
MI
01
—
2505210422
BLUE CROSS BLUE SHIELD MI
MI
Enumeration date
02/07/2006
Last updated
05/20/2008
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