Provider Demographics
NPI:1780685008
Name:HISSONG, CECELIA F (MD)
Entity Type:Individual
Prefix:DR
First Name:CECELIA
Middle Name:F
Last Name:HISSONG
Suffix:
Gender:F
Credentials:MD
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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
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2010-02-12
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Provider Licenses
StateLicense IDTaxonomies
MI027214207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0824144OtherBLUE CROSS BLUE SHIELD
MI1780685008OtherHAP
MI10/2095139Medicaid
MI126367OtherPRIORITY HEALTH
MI1780685008OtherBLUE CARE NETWORK
MI382211173OtherALL OTHERS ON 8/9/05
MI010045869OtherRAILROAD MEDICARE
MI1780685008OtherBLUE CARE NETWORK
MI126367OtherPRIORITY HEALTH