Organization
MANSOUR MERCY MEDICAL CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALAA G MANSOUR M.D (PRESADENT)
(586) 443-5580
Entity
Organization
Contact information
Practice address
21321 KELLY RD STE 100, EASTPOINTE, MI 48021-3214
(586) 443-5580
(586) 443-5590
Mailing address
21321 KELLY RD STE 100, EASTPOINTE, MI 48021-3214
(586) 443-5580
(586) 443-5590
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
AM078660
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1105015892
BCBS
MI
05
—
4717292
—
MI
Enumeration date
11/01/2006
Last updated
10/08/2024
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