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General NPI Number Information
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NPI Number | 1144497694
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Entity Type | Organization
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Legal Business Name | ADVANCED FOOT & ANKLE CARE CENTER PLLC
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Dates
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Enumeration Date | 05/14/2008
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Last Update Date | 03/09/2009
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Provider Practice Location Address
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Address Line | 24230 KARIM BLVD STE 140
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City | NOVI
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State | MI
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Zip | 48375-2953
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Country | US
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Telephone | 248-888-9500
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Fax | 248-888-9504
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Provider Business Mailing Address
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Address Line | 24230 KARIM BLVD STE 140
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City | NOVI
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State | MI
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Zip | 48375-2953
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Country | US
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Telephone | 248-888-9500
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Fax | 248-888-9504
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Authorized Official
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Title or Position | OWNER
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Name | DR. ISSAM N. MANSOUR
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Credential | DPM
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Telephone | 248-888-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 5901002177
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License Number State | MI
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