Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | SM038518 | MI |
NPI | 1053334177 |
---|---|
Provider Name | Dr. Shahrokh Mansoori |
First Address | Rochester Hills, MI 48307-4599 |
Second Address | Rochester Hills, MI 48307-4599 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 28/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1404338 | (05) | MI |
3306336001 | BLUE CROSS (01) | MI |
A76184 | (02) |