Provider Demographics
NPI:1174661763
Name:ABESSINIO, CARMELA A (DO)
Entity Type:Individual
Prefix:DR
First Name:CARMELA
Middle Name:A
Last Name:ABESSINIO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:15450 E JEFFERSON AVE
Mailing Address - Street 2:STE 150
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48230-2028
Mailing Address - Country:US
Mailing Address - Phone:313-885-1320
Mailing Address - Fax:313-885-1325
Practice Address - Street 1:15450 E JEFFERSON AVE
Practice Address - Street 2:STE 150
Practice Address - City:GROSSE POINTE
Practice Address - State:MI
Practice Address - Zip Code:48230-2028
Practice Address - Country:US
Practice Address - Phone:313-885-1320
Practice Address - Fax:313-885-1325
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101011019207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1658200134OtherBLUE CROSS BLUE SHIELD
MI1658200134OtherBLUE CROSS BLUE SHIELD