Provider Demographics
NPI:1609822865
Name:DADIVAS, CECILE CATALAN (MD)
Entity Type:Individual
Prefix:
First Name:CECILE
Middle Name:CATALAN
Last Name:DADIVAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:DEPARTMENT 272801
Mailing Address - Street 2:PO BOX 67000
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-2728
Mailing Address - Country:US
Mailing Address - Phone:517-841-6913
Mailing Address - Fax:517-841-6917
Practice Address - Street 1:7845 SPRING ARBOR RD
Practice Address - Street 2:
Practice Address - City:SPRING ARBOR
Practice Address - State:MI
Practice Address - Zip Code:49283-9785
Practice Address - Country:US
Practice Address - Phone:517-750-3038
Practice Address - Fax:517-750-3482
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301069821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00220196OtherRR MEDICARE
MIN72760007Medicare ID - Type UnspecifiedWA FOOTE MEMORIAL
MIP00220196OtherRR MEDICARE