Provider Demographics
NPI:1316193436
Name:CARMELA ABESSINIO PC
Entity Type:Organization
Organization Name:CARMELA ABESSINIO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABESSINIO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-885-1320
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-08
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011019207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P24660Medicare PIN