Mansour Mercy Medical Center Pllc | |
19011 E 10 Mile Rd Roseville MI 48066-3984 | |
(586) 443-5580 | |
Not Available |
Full Name | Mansour Mercy Medical Center Pllc |
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Speciality | Family Medicine |
Location | 19011 E 10 Mile Rd, Roseville, Michigan |
Authorized Official Name and Position | Alaa Mansour (PRESIDENT) |
Authorized Official Contact | 5864435580 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Mansour Mercy Medical Center Pllc 19011 E 10 Mile Rd Roseville MI 48066-3984 Ph: (586) 443-5580 | Mansour Mercy Medical Center Pllc 19011 E 10 Mile Rd Roseville MI 48066-3984 Ph: (586) 443-5580 |
NPI Number | 1699852343 |
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Provider Enumeration Date | 11/01/2006 |
Last Update Date | 01/21/2021 |
Medicare PECOS PAC ID | 8820045503 |
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Medicare Enrollment ID | O20050405000614 |
Identifier | Type | State | Issuer |
---|---|---|---|
1699852343 | NPI | - | NPPES |
1105015892 | Other | MI | BCBS |
4717292 | Medicaid | MI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | AM078660 (Michigan) | Primary |
Provider Name | Alaa Mansour |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1902896608 PECOS PAC ID: 3577528850 Enrollment ID: I20041129000416 |
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