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Individual

RAMY MANSOUR

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
5701 BOW POINTE DR STE 370, CLARKSTON, MI 48346-5403
(248) 625-4055
Mailing address
5701 BOW POINTE DR # 370, CLARKSTON, MI 48346-3198
(248) 625-4055

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
5101020250
MI
207RG0100X
Gastroenterology Physician
Primary
5101020250
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
5101020250
MEDICAL LICENSE
MI
01
5315059035
CONTROLLED SUBSTANCE LICENSE
MI
Enumeration date
04/16/2013
Last updated
10/18/2023
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