Provider Demographics
NPI:1154441160
Name:YOUSIF MANSOUR MD PC
Entity Type:Organization
Organization Name:YOUSIF MANSOUR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUSIF
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-559-2280
Mailing Address - Street 1:17070 W 12 MILE RD
Mailing Address - Street 2:SUITE 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:248-559-6752
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:248-559-6752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-31
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty