Provider Demographics
NPI:1124359658
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:DR
Authorized Official - First Name:CECELIA
Authorized Official - Middle Name:F
Authorized Official - Last Name:HISSONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-563-5310
Mailing Address - Street 1:23100 CHERRY HILL ST
Mailing Address - Street 2:SUITE 8
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 ST
Practice Address - Street 2:SUITE 8
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:2010-01-22
Last Update Date:2010-01-22
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
MI080824144OtherBLUE CROSS BLUE SHIELD OF MI
MI102095139Medicaid
MI080824144OtherBLUE CARE NETWORK
MIB44598OtherHEALTH ALLIANCE PLAN
MI010045869OtherRAILROAD MEDICARE
MI=========OtherNGS
MI010045869OtherRAILROAD MEDICARE
MIB44598OtherHEALTH ALLIANCE PLAN
MI102095139Medicaid
MI080824144OtherBLUE CARE NETWORK