Individual
DR. IMAD M MANSOOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
42557 WOODWARD AVE STE 110, BLOOMFIELD HILLS, MI 48304-5206
(248) 454-1004
(248) 332-9489
Mailing address
42557 WOODWARD AVE STE 130, BLOOMFIELD HILLS, MI 48304-5206
(248) 454-1004
(248) 332-9489
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301407249
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1295023547
NPI TYPE II
MI
05
—
4255895
—
MI
01
—
MI4898373
INDIVIDUAL MEDICARE PTAN #
MI
01
—
MI4989
GROUP MEDICARE PTAN
MI
Enumeration date
08/27/2006
Last updated
03/29/2019
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