MEDICARE: KAAZMI MANSOUR

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	1041C0700X	Clinical Social Worker	6801116795	MI

General Provider Information

NPI Number	:	1851162499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAAZMI MANSOUR

Provider Business Mailing Address
First Line	:	880 W LONG LAKE RD STE 225
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48098-4531
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	880 W LONG LAKE RD STE 225
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48098-4531
Country	:	US
Telephone Number	:	248-533-0809
Fax Number	:

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

Provider Enumeration Date	:	01/11/2024
Last Update Date	:	04/10/2025

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Directions to “ KAAZMI MANSOUR ” Practice Location

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