Provider Demographics
NPI:1952390031
Name:MANSOUR-HABIB, NANCY F (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:F
Last Name:MANSOUR-HABIB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:FAWZY
Other - Last Name:MANSOUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3940 JOHN R RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5688
Mailing Address - Country:US
Mailing Address - Phone:248-688-9500
Mailing Address - Fax:248-688-9497
Practice Address - Street 1:3940 JOHN R RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-5688
Practice Address - Country:US
Practice Address - Phone:248-688-9500
Practice Address - Fax:248-688-9497
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301065650207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ON60940Medicare ID - Type Unspecified
G81793Medicare UPIN