MEDICARE: DR. LENA TALAL MANSOUR 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	207R00000X	Internal Medicine Physician	0	MI

General Provider Information

NPI Number	:	1780265249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LENA TALAL MANSOUR MD.

Provider Business Mailing Address
First Line	:	5843 17 MILE RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-6873
Country	:	US
Telephone Number	:	586-722-7741
Fax Number	:	586-883-9970

Provider Business Practice Location Address
First Line	:	5843 17 MILE RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-6873
Country	:	US
Telephone Number	:	586-722-7741
Fax Number	:	586-883-9970

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

Provider Enumeration Date	:	04/16/2021
Last Update Date	:	10/01/2024

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