Candice Ann Mansoor, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

4301105691 Issued in MI

Practice address

15125 22 Mile Rd
Shelby TWP, MI 48315

Phone

(586) 532-0599

NPI assigned

May 1, 2014

Last updated

Jul 11, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Candice Ann Attisha Former name

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: candice.mansoor.1@7131.direct.athenahealth.com
• Direct secure messaging: cmansoor57601@direct.hfhs.org

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

• Hurley Medical Center

  dba Hurley OB/GYN Research & Education

  • Obstetrics & Gynecology Physician
  • Flint, MI
  • NPI 1982630844
  Medicare reassignment NPD
• Hurley Medical Center

  • Plastic and Reconstructive Surgery Physician
  • Flint, MI
  • NPI 1689345761
  NPD
• Hurley Medical Center

  dba HurleyPediatric Research & Education

  • Pediatrics Physician
  • Flint, MI
  • NPI 1821024910
  NPD
• Shelby Pediatric Associates and Child Lung Center PC

  • Pediatrics Physician
  • Shelby Township, MI
  • NPI 1124051990
  NPD (past)

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

{
    "created_epoch": "1398902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531267200000",
    "number": "1821408790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15125 22 MILE RD",
            "city": "SHELBY TWP",
            "state": "MI",
            "postal_code": "483154406",
            "telephone_number": "586-532-0599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15125 22 MILE RD",
            "city": "SHELBY TWP",
            "state": "MI",
            "postal_code": "48315",
            "telephone_number": "586-532-0599"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 E 1st St",
            "address_purpose": "LOCATION",
            "city": "Flint",
            "state": "MI",
            "postal_code": "485021900",
            "country_code": "US",
            "telephone_number": "810-262-9773",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4967 Crooks Rd Ste 250",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "MI",
            "postal_code": "480985809",
            "country_code": "US",
            "telephone_number": "248-633-2025",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2005 Klingensmith Rd",
            "address_2": "Unit 67",
            "address_purpose": "LOCATION",
            "city": "Bloomfield Hills",
            "state": "MI",
            "postal_code": "483020279",
            "country_code": "US",
            "telephone_number": "248-390-5091",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANSOOR",
        "first_name": "CANDICE",
        "middle_name": "ANN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-01",
        "last_updated": "2018-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301105691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CANDICE",
            "last_name": "ATTISHA",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Boby Philip Manalel, PT
• Ramy Mando, M.D.
• Adam Ryan Mandziuk, D.C.
• Mary Manni
• Rebecca A Manring, PT
• Mark R Sullivan DDS
• James Martin
• Lacey Martinez
• Tracy Marzec, PTA
• Matrix Medical PLLC

• Pediatrics Physician in Shelby TWP, MI
• Providers in Shelby TWP, MI by specialty
• Pediatrics Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.