Organization
FAIZ MANSOUR, M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAIZ MANSOUR (OWNER)
(248) 334-3792
Entity
Organization
Contact information
Practice address
10 W SQUARE LAKE RD, SUITE 202, BLOOMFIELD HILLS, MI 48302-0465
(248) 452-9500
Mailing address
10 W SQUARE LAKE RD, 202, BLOOMFIELD HILLS, MI 48302-0465
(248) 452-9500
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
4301059179
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4255901
—
MI
Enumeration date
01/10/2008
Last updated
05/20/2008
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