MEDICARE: DR. MICHAEL MANSOUR M.D.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	10715	MS
2	207RI0011X	Interventional Cardiology Physician	44178	AL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	060048938	OTHER	MS	MEDICARE RAILROAD

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1326077058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL MANSOUR M.D.

Provider Business Mailing Address
First Line	:	1700 SPRING HILL AVE STE 100
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36604-1416
Country	:	US
Telephone Number	:	251-435-1200
Fax Number	:	251-435-6357

Provider Business Practice Location Address
First Line	:	1700 SPRING HILL AVE STE 100
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36604-1416
Country	:	US
Telephone Number	:	251-435-1200
Fax Number	:	251-435-6357

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	06/08/2022

67 WALNUT AVE
CLARK, NJ
07066-1640

Practice Phone: 732-388-7300
Practice Fax: 732-388-1330