Provider Demographics
NPI:1881386811
Name:COMSA MCCORMACK, ISABELLA CRISTINA (DO)
Entity type:Individual
Prefix:DR
First Name:ISABELLA
Middle Name:CRISTINA
Last Name:COMSA MCCORMACK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:ISABELLA
Other - Middle Name:
Other - Last Name:COMSA MCCORMACK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3601 W 13 MILE RD OFC
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6712
Mailing Address - Country:US
Mailing Address - Phone:248-898-0413
Mailing Address - Fax:
Practice Address - Street 1:3535 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6770
Practice Address - Country:US
Practice Address - Phone:248-551-3000
Practice Address - Fax:248-551-2032
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5151016021208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics