Provider Demographics
NPI:1780645036
Name:NAINI, MANSOOR G (MD)
Entity Type:Individual
Prefix:DR
First Name:MANSOOR
Middle Name:G
Last Name:NAINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2294 LONE PINE RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-3611
Mailing Address - Country:US
Mailing Address - Phone:734-459-7444
Mailing Address - Fax:734-459-7755
Practice Address - Street 1:4020 VENOY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-1869
Practice Address - Country:US
Practice Address - Phone:734-459-7444
Practice Address - Fax:734-459-7744
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIMN036991207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3405307Medicaid
MID83134Medicare UPIN
MI0N78530Medicare ID - Type Unspecified