Faiz Mansour, M.D., P.C.

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

4301059179 Issued in MI

Legal business name

FAIZ MANSOUR, M.D., P.C.

Practice address

10 W Square Lake Rd
Suite 202
Bloomfield Hills, MI 48302-0465

Phone

(248) 452-9500

NPI assigned

Jan 10, 2008

Organization subpart

No

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

Authorized official

Name

Faiz MansourNPI 1508974999

Title

Owner

Phone

(248) 334-3792

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Practitioners 2

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

• Faiz Mansour, M.D.

  • Internal Medicine Physician
  • Bloomfield Hills, MI
  • NPI 1508974999
  Medicare reassignment NPD Authorized official
• Renee Kinaia, NP

  • Adult Health Nurse Practitioner
  • Sterling Heights, MI
  • NPI 1073028130
  NPD (past)

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

{
    "created_epoch": "1199923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211241600000",
    "number": "1770769630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 W SQUARE LAKE RD",
            "address_2": "202",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483020465",
            "telephone_number": "248-452-9500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 W SQUARE LAKE RD",
            "address_2": "SUITE 202",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483020465",
            "telephone_number": "248-452-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIZ MANSOUR, M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-10",
        "last_updated": "2008-05-20",
        "status": "A",
        "authorized_official_last_name": "MANSOUR",
        "authorized_official_first_name": "FAIZ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-334-3792"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "MI",
            "license": "4301059179",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4255901",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Exclusive Provider Organization in Bloomfield Hills, MI
• Providers in Bloomfield Hills, MI by specialty
• Exclusive Provider Organization in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.