Individual
PETER MANCINI II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2881 MONROE ST, DEARBORN, MI 48124-3475
(313) 562-3232
(313) 563-3330
Mailing address
19768 BEVERLY RD, BEVERLY HILLS, MI 48025-3911
(313) 418-6001
(248) 792-9159
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
4301061557
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060064248
MEDICARE RR
—
01
—
0Q26305005
BLUECROSSBLUESHIELD OF MI
MI
05
—
4308863
—
MI
01
—
P112550
BLUECARENETWORK
MI
Enumeration date
07/03/2006
Last updated
04/14/2015
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