1154441160 NPI number — YOUSIF MANSOUR MD PC

Table of content: (NPI 1154441160)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154441160 NPI number — YOUSIF MANSOUR MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YOUSIF MANSOUR MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154441160
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17070 W 12 MILE RD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48076-2116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-559-2280
Provider Business Mailing Address Fax Number:
248-559-6752

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17070 W 12 MILE RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48076-2116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-559-2280
Provider Business Practice Location Address Fax Number:
248-559-6752
Provider Enumeration Date:
03/31/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MANSOUR
Authorized Official First Name:
YOUSIF
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
248-559-2280

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)