Individual
CANDICE ANN MANSOOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
15125 22 MILE RD, SHELBY TWP, MI 48315
(586) 532-0599
Mailing address
15125 22 MILE RD, SHELBY TWP, MI 48315-4406
(586) 532-0599
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301105691
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/01/2014
Last updated
07/11/2018
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