Provider Demographics
NPI:1821491283
Name:ARACELI C MESIONA-BRUCAL MD PLLC
Entity Type:Organization
Organization Name:ARACELI C MESIONA-BRUCAL MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARACELI
Authorized Official - Middle Name:
Authorized Official - Last Name:MESIONA-BRUCAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-463-3375
Mailing Address - Street 1:8683 RED ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:MI
Mailing Address - Zip Code:49098-9761
Mailing Address - Country:US
Mailing Address - Phone:269-463-3375
Mailing Address - Fax:269-463-3487
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079223207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty