MEDICARE: DR. SHAHROKH MANSOORI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	SM038518	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3306336001	OTHER	MI	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053334177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAHROKH MANSOORI MD

Provider Business Mailing Address
First Line	:	135 BARCLAY CIR
Second Line	:	STE 109
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-4599
Country	:	US
Telephone Number	:	248-844-2980
Fax Number	:	248-844-2983

Provider Business Practice Location Address
First Line	:	135 BARCLAY CIR
Second Line	:	STE 109
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-4599
Country	:	US
Telephone Number	:	248-844-2980
Fax Number	:	248-844-2983

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	04/28/2010

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