Provider Demographics
NPI:1669636007
Name:MANSURI, OVEYS (MD)
Entity type:Individual
Prefix:
First Name:OVEYS
Middle Name:
Last Name:MANSURI
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 1:1000 HOUGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-5303
Mailing Address - Country:US
Mailing Address - Phone:989-790-1001
Mailing Address - Fax:989-790-1002
Practice Address - Street 1:912 S WASHINGTON AVE STE 1
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-2578
Practice Address - Country:US
Practice Address - Phone:989-790-1001
Practice Address - Fax:989-790-1002
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE266382086S0102X, 2086S0127X
MI43011165432086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care