Provider Demographics
NPI:1194831172
Name:MANSION, HAMPTON JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:HAMPTON
Middle Name:JOSEPH
Last Name:MANSION
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:20755 GREENFIELD RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5403
Mailing Address - Country:US
Mailing Address - Phone:248-557-3777
Mailing Address - Fax:248-557-2666
Practice Address - Street 1:20755 GREENFIELD RD
Practice Address - Street 2:SUITE 107
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5403
Practice Address - Country:US
Practice Address - Phone:248-557-3777
Practice Address - Fax:248-557-2666
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101008444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2746956Medicaid
MI2746956Medicaid
E91118Medicare UPIN