Provider Demographics
NPI:1154330355
Name:MANSOUR, YOUSIF S (MD)
Entity Type:Individual
Prefix:DR
First Name:YOUSIF
Middle Name:S
Last Name:MANSOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:17070 W 12 MILE RD
Mailing Address - Street 2:STE A
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2116
Mailing Address - Country:US
Mailing Address - Phone:248-559-2280
Mailing Address - Fax:248-559-3752
Practice Address - Street 1:17070 W 12 MILE RD
Practice Address - Street 2:SUITE A
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2116
Practice Address - Country:US
Practice Address - Phone:248-559-2280
Practice Address - Fax:248-559-3752
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIYMO44148207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2630979Medicaid
MI2630979Medicaid
MI0606306Medicare ID - Type Unspecified