Organization
MANOO BOONSIRI,M.D.,P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANOO BOONSIRI M.D. (PRESIDENT)
(734) 243-5822
Entity
Organization
Contact information
Practice address
10501 TELEGRAPH RD, SUITE 102, TAYLOR, MI 48180-3375
(313) 295-7822
(734) 241-3350
Mailing address
730 N MACOMB ST, SUITE 415, MONROE, MI 48162-2900
(734) 243-5822
(734) 241-3350
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
35446
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1798170
—
MI
01
—
3305801051
BLUECROSS BLUESHIELD MI
MI
Enumeration date
09/27/2006
Last updated
12/23/2010
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