Individual
IRFAN MAMOUN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
36175 HARPER AVE, CLINTON TOWNSHIP, MI 48035-3274
(586) 741-3772
Mailing address
22550 BARD AVE, FAIRVIEW PARK, OH 44126-2907
(440) 378-4186
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301038517
MI
2085R0202X
Diagnostic Radiology Physician
ME141698
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301038517
MEDICAL LICENSE
MI
Enumeration date
12/04/2008
Last updated
04/12/2023
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