Mansurov, Alay

Mansurov, Alay is an individual health care provider with primary practice located at 1580 Commanche Ave , Green Bay WI 54313-5751. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Hematology & Oncology. Allopathic & Osteopathic Physicians / Hematology & Oncology is his primary health care specialty. Mansurov, Alay can be contacted via phone (920) 435-8326.

Contact Information

Primary practice address
1580 Commanche Ave Green Bay WI 54313-5751
Phone: (920) 435-8326
Fax: (920) 430-4659
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 125.067089 Illinois
Allopathic & Osteopathic Physicians / Hematology & Oncology 207RH0003X 72453-20 Wisconsin

Profile Details

NPI number 1033592035
LBN Legal business name Mansurov, Alay
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 8th, 2015
Last updated May 26th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1033592035 NPPES
Other 389016 AMERICAN BOARD OF INTERNAL MEDICINE/HEMATOLOGY AND ONCOLOGY

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