Provider Demographics
NPI:1033295167
Name:CECELIA F. HISSONG, M. D., P. C.
Entity Type:Organization
Organization Name:CECELIA F. HISSONG, M. D., P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CECELIA
Authorized Official - Middle Name:F
Authorized Official - Last Name:HISSONG
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:313-563-5310
Mailing Address - Street 1:23100 CHERRY HILL RD.
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1493
Mailing Address - Country:US
Mailing Address - Phone:313-563-5310
Mailing Address - Fax:313-563-8147
Practice Address - Street 1:23100 CHERRY HILL RD.
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1493
Practice Address - Country:US
Practice Address - Phone:313-563-5310
Practice Address - Fax:313-563-8147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICH027214207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB44598OtherHAP ID
MI0824144OtherBLUE CARE NETWORK ID
MIC3390OtherM-CARE ID
MI10/2095139Medicaid
MI126367OtherCARE CHOICES
MI080824144OtherBLUE CROSS BLUE SHIELD ID
MI0824144OtherBLUE CARE NETWORK ID
MI=========OtherPHCS ID
MI126367OtherCARE CHOICES
MIB44598OtherHAP ID
MI=========OtherFIRST HEALTH ID
MI=========OtherNGS AMERICAN ID
MIB44598Medicare UPIN