Provider Demographics
NPI:1154300218
Name:ALMANSOUR, MUHAMMAD AMMAR (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:AMMAR
Last Name:ALMANSOUR
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 1:4071 RICHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48506-2008
Mailing Address - Country:US
Mailing Address - Phone:810-736-2440
Mailing Address - Fax:
Practice Address - Street 1:4071 RICHFIELD RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506-2008
Practice Address - Country:US
Practice Address - Phone:810-736-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063474207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4360667Medicaid
MI4360667Medicaid
G87263Medicare UPIN