ANTHEM VISITING PHYSICIANS, P.C.
Osteopathic Medicine at Brookwood Walke, Bloomfield, MI

License number
Michigan 4301063082
Category
Osteopathic Medicine
Type
Internal Medicine
Owner
Name: DR. MARLENE T MANSOUR MD
Title: OWNER
Phone: (313) 205-8473
Address
Address
715 Brookwood Walke, Bloomfield, MI 48304
National Provider ID: 1700037223
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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ANTHEM VISITING PHYSICIANS, PC

Bloomfield, MI

Status:
Inactive
Industry:
Business Services at Non-Commercial Site
Doing business as:
Anthem Visiting Physicians
Registration:
Mar 19, 2007
Addresses:
715 Brookwood Walke, Bloomfield Hills, MI 48304 (Physical)
Michigan (Mailing)
715 Brockmoor Ln, Bloomfield, MI 48304
State ID:
00526W
Business type:
Domestic Professional Service Corporation
Expiration:
12-8-2010
Principal:
Marlene Mansour (Principal)
Agent:
Marlene T. Mansour, M.d

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