Individual provider Active NPI

Dalia Mansour, M.D.

  • Neurology Physician
  • Detroit, MI
National Provider Identifier
1699127548
Registry record updated Jun 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
4301502880 Issued in MI
Practice address
4201 Saint Antoine St
Detroit, MI 48201-2153
Phone
(313) 745-1302
Fax
(135) 774-6413
NPI assigned
Jul 4, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 29, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301110860 MI
General Practice Physician 208D00000X 81232 GA
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X 4301502880 MI Primary

Addresses

Primary practice location

4201 Saint Antoine St
Detroit, MI 48201-2153

Mailing address

1000 Harrington St
Mount Clemens, MI 48043-2920
Phone (586) 493-8000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220630002329 MI Practitioner - Neurology 3173800836 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
McLaren MacombGroup PAC ID 8921912791, 131 clinicians

Practice addresses (Care Compare)

1000 Harrington St
Mount Clemens, MI 48043-2920
Phone (810) 493-8000

37399 Garfield Rd
Clinton Township, MI 48036-3672

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
81232GAMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
McLaren Northern Michigan Multi-Specialty CurrentSince Feb 1, 2024 Accepting new patients
McLaren Northern Michigan CurrentSince Feb 1, 2024 Accepting new patients
McLaren Macomb Multi-Specialty CurrentSince Jun 29, 2022 Accepting new patients
McLaren Macomb Past Accepting new patients

Locations

37399 Garfield Rd
Ste 203
Clinton Twp, MI 48036
Phone (586) 228-2911

4201 Saint Antoine St
Detroit, MI 48201
Phone (313) 745-3615

4201 Saint Antoine St
Ste 8A
Detroit, MI 48201
Phone (313) 577-8114

1030 Harrington St
Ste LL001
Mount Clemens, MI 48043
Phone (586) 493-3297

1000 Harrington St
Mount Clemens, MI 48043
Phone (586) 493-3727

2390 Mitchell Park Dr
Ste D
Petoskey, MI 49770
Phone (231) 242-1760

416 Connable Ave
Petoskey, MI 49770
Phone (231) 487-4000

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1467590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656460800000",
    "number": "1699127548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 HARRINGTON ST",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480432920",
            "telephone_number": "586-493-8000",
            "fax_number": "586-493-8799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 SAINT ANTOINE ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012153",
            "telephone_number": "313-745-1302",
            "fax_number": "135-774-6413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANSOUR",
        "first_name": "DALIA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-07-04",
        "last_updated": "2022-06-29",
        "certification_date": "2022-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301110860",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "GA",
            "license": "81232",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "4301502880",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.