Healthcare Provider Details

I. General information

NPI: 1689169708
Provider Name (Legal Business Name): MNOURN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2018
Last Update Date: 07/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30700 TELEGRAPH RD STE 1536
BINGHAM FARMS MI
48025-4590
US

IV. Provider business mailing address

30700 TELEGRAPH RD STE 1536
BINGHAM FARMS MI
48025-4590
US

V. Phone/Fax

Practice location:
  • Phone: 248-215-0048
  • Fax:
Mailing address:
  • Phone: 248-215-0048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DIANA EL MASRI
Title or Position: BILLING MANAGER
Credential:
Phone: 248-215-0048