Provider Demographics
NPI:1326009861
Name:MANSOUR, SABRY GEORGE (MD)
Entity Type:Individual
Prefix:MR
First Name:SABRY
Middle Name:GEORGE
Last Name:MANSOUR
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 1:25 MILLVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446
Mailing Address - Country:US
Mailing Address - Phone:810-538-2020
Mailing Address - Fax:810-538-2001
Practice Address - Street 1:25 MILLVILLE ROAD
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446
Practice Address - Country:US
Practice Address - Phone:810-538-2020
Practice Address - Fax:810-538-2001
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4301081399208800000X
MI4301081399208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4717381Medicaid
N98390004Medicare ID - Type Unspecified