Provider Demographics
NPI:1578572517
Name:MESIONA-BRUCAL, ARACELI CEMPRON (MD)
Entity Type:Individual
Prefix:DR
First Name:ARACELI
Middle Name:CEMPRON
Last Name:MESIONA-BRUCAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:MI
Mailing Address - Zip Code:49098-9366
Mailing Address - Country:US
Mailing Address - Phone:269-463-3603
Mailing Address - Fax:
Practice Address - Street 1:8683 RED ARROW HWY
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:MI
Practice Address - Zip Code:49098-9761
Practice Address - Country:US
Practice Address - Phone:269-463-3375
Practice Address - Fax:269-463-3487
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079223207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4470892Medicaid
MI4470892Medicaid
MI0N65140Medicare ID - Type Unspecified