Individual
MRS. MARLENE TEJANO MANSOUR
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
43134 DEQUINDRE RD, STERLING HTS, MI 48314
(586) 739-5000
(586) 739-5551
Mailing address
43134 DEQUINDRE RD, STERLING HTS, MI 48314
(586) 739-5000
(586) 739-5551
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301063082
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3506326422
BLUE CROSS
MI
Enumeration date
03/21/2006
Last updated
07/08/2007
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