NPIMap

Organization Active NPI

Michigan Medical Diagnostic Center PC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Rochester Hills, MI
National Provider Identifier
1093941908
Registry record updated Jan 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
SM038518 Issued in MI
Legal business name
MICHIGAN MEDICAL DIAGNOSTIC CENTER PC
Practice address
135 Barclay Cir
Suite 109
Rochester Hills, MI 48307-4599
Phone
(248) 844-2980
Fax
(248) 844-2983
NPI assigned
Jun 5, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Shahrokh Mansoori, M.D.NPI 1053334177
Title
Owner
Phone
(248) 844-2980

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X NM074148 MI
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X AM076045 MI
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208G00000X SM038518 MI Primary

Addresses

Primary practice location

135 Barclay Cir
Suite 109
Rochester Hills, MI 48307-4599

Mailing address

135 Barclay Cir
Suite 109
Rochester Hills, MI 48307-4599
Phone (248) 844-2980

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1244160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326067200000",
    "number": "1093941908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 BARCLAY CIR",
            "address_2": "SUITE 109",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483074599",
            "telephone_number": "248-844-2980",
            "fax_number": "248-844-2983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 BARCLAY CIR",
            "address_2": "SUITE 109",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483074599",
            "telephone_number": "248-844-2980",
            "fax_number": "248-844-2983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN MEDICAL DIAGNOSTIC CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-05",
        "last_updated": "2012-01-09",
        "status": "A",
        "authorized_official_last_name": "MANSOORI",
        "authorized_official_first_name": "SHAHROKH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-844-2980",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "NM074148",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "AM076045",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "MI",
            "license": "SM038518",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester Hills, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.