Organization
ANTHEM VISITING PHYSICIANS, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARLENE T MANSOUR MD (OWNER)
(313) 205-8473
Entity
Organization
Contact information
Practice address
715 BROOKWOOD WALKE, BLOOMFIELD HILLS, MI 48304-1901
(313) 205-8473
Mailing address
715 BROOKWOOD WALKE, BLOOMFIELD HILLS, MI 48304-1901
(313) 205-8473
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301063082
MI
Other
Enumeration date
10/02/2008
Last updated
10/02/2008
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