Provider Demographics
NPI:1134930563
Name:RAHMAN, MANSURUN
Entity type:Individual
Prefix:
First Name:MANSURUN
Middle Name:
Last Name:RAHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 SERRA DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5251
Mailing Address - Country:US
Mailing Address - Phone:248-989-5801
Mailing Address - Fax:
Practice Address - Street 1:2233 SERRA DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5251
Practice Address - Country:US
Practice Address - Phone:248-989-5801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program