Provider Demographics
NPI:1366575839
Name:BOONSIRI, MANOO (MD)
Entity type:Individual
Prefix:DR
First Name:MANOO
Middle Name:
Last Name:BOONSIRI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:730 N MACOMB ST
Mailing Address - Street 2:SUITE 415
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-2900
Mailing Address - Country:US
Mailing Address - Phone:734-243-5822
Mailing Address - Fax:734-241-3350
Practice Address - Street 1:10501 TELEGRAPH RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3375
Practice Address - Country:US
Practice Address - Phone:313-295-7822
Practice Address - Fax:734-241-3350
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI35446208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3305801051OtherBCBS OF MI
MI3305801051OtherBCBS OF MI
0820673Medicare ID - Type Unspecified