Individual
ALAA NAIM MANSOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M
Contact information
Practice address
17000 EXECUTIVE PLAZA DR STE 101, DEARBORN, MI 48126-2793
(313) 565-4948
(313) 565-4989
Mailing address
17000 EXECUTIVE PLAZA DR, STE 101, DEARBORN, MI 48126-2793
(313) 565-4948
(313) 565-4989
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
5901002591
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300013898
—
IN
Enumeration date
06/30/2015
Last updated
10/21/2019
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