Provider Demographics
NPI:1952562241
Name:A. ALMANSOUR M.D., P.C.
Entity type:Organization
Organization Name:A. ALMANSOUR M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:AMMAR
Authorized Official - Last Name:ALMANSOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-736-2440
Mailing Address - Street 1:4071 RICHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48506-2008
Mailing Address - Country:US
Mailing Address - Phone:810-736-2440
Mailing Address - Fax:810-736-3330
Practice Address - Street 1:4071 RICHFIELD RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506-2008
Practice Address - Country:US
Practice Address - Phone:810-736-2440
Practice Address - Fax:810-736-3330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063474207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4360667Medicaid
MIG87263Medicare UPIN
MI0N39080Medicare PIN