Provider Demographics
NPI:1700868726
Name:SESSA, GINO R (MD)
Entity Type:Individual
Prefix:DR
First Name:GINO
Middle Name:R
Last Name:SESSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 W 13 MILE RD
Mailing Address - Street 2:STE 437
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073
Mailing Address - Country:US
Mailing Address - Phone:248-288-2210
Mailing Address - Fax:248-280-0505
Practice Address - Street 1:3535 W 13 MILE RD
Practice Address - Street 2:STE 437
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073
Practice Address - Country:US
Practice Address - Phone:248-288-2210
Practice Address - Fax:248-280-0505
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301064088208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0767220001OtherADMINISTAR FEDERAL
MI0F31114OtherBCBS
MI0F33583OtherBCBC DME
MI3476200Medicaid
MI4424423Medicaid
MI0767220001OtherADMINISTAR FEDERAL
MIG43534Medicare UPIN
MI0M08420013Medicare PIN
MI3476200Medicaid