Provider Demographics
NPI:1487094074
Name:AMAN, MANSOOR MOHAMMAD (MD)
Entity type:Individual
Prefix:DR
First Name:MANSOOR
Middle Name:MOHAMMAD
Last Name:AMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1716 LAWRENCE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-9108
Mailing Address - Country:US
Mailing Address - Phone:920-276-8600
Mailing Address - Fax:920-632-6806
Practice Address - Street 1:1716 LAWRENCE DR STE 103
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-9108
Practice Address - Country:US
Practice Address - Phone:920-276-8600
Practice Address - Fax:920-632-6806
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI68012208VP0014X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100078413Medicaid