Provider Demographics
NPI:1073531034
Name:HAROON, MANZOOR (MD)
Entity Type:Individual
Prefix:
First Name:MANZOOR
Middle Name:
Last Name:HAROON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24335 FAIRMOUNT DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1539
Mailing Address - Country:US
Mailing Address - Phone:313-274-8833
Mailing Address - Fax:313-946-5551
Practice Address - Street 1:24887 GODDARD RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3930
Practice Address - Country:US
Practice Address - Phone:734-946-7200
Practice Address - Fax:734-946-5551
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMH036971207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI209730210Medicaid
MIM99110001Medicare ID - Type Unspecified
MIB45073Medicare UPIN