Provider Demographics
NPI:1467629493
Name:MANSURI, SAIMABANU S (MD)
Entity Type:Individual
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First Name:SAIMABANU
Middle Name:S
Last Name:MANSURI
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Gender:F
Credentials:MD
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Mailing Address - Street 1:130 TOWN CENTER DR STE 203
Mailing Address - Street 2:BEAUMONT MEDICAL STAFF AFFAIRS
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-1744
Mailing Address - Country:US
Mailing Address - Phone:248-585-8218
Mailing Address - Fax:248-585-8266
Practice Address - Street 1:3535 W 13 MILE RD # 248
Practice Address - Street 2:BEAUMONT CHRONIC DISEASE MANAGEMENT CLINIC
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6770
Practice Address - Country:US
Practice Address - Phone:248-551-1515
Practice Address - Fax:248-551-1516
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2020-10-22
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Provider Licenses
StateLicense IDTaxonomies
MI4301090163207RN0300X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology