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General NPI Number Information
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NPI Number | 1710332606
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Entity Type | Individual
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Provider Name | MOHAMED BOSHER MANSOUR MD
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Gender | Male
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Dates
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Enumeration Date | 04/27/2016
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 21000 E 12 MILE RD STE 112
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48081-1156
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Country | US
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Telephone | 586-772-5550
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Fax | 586-772-2470
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Provider Business Mailing Address
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Address Line | 50505 SCHOENHERR RD STE 290
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48315-3141
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Country | US
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Telephone | 586-314-0080
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Fax | 877-673-3562
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301109257
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 35135917
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License Number State | OH
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