Individual
BRANDON M MANSOOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 W VOTAW ST, PORTLAND, IN 47371-1322
(260) 726-1821
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301108185
MI
2085R0202X
Diagnostic Radiology Physician
Primary
01087994A
IN
Other
Enumeration date
06/22/2015
Last updated
08/03/2022
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