MEDICARE: CECELIA F. HISSONG, M. D., P. C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	CH027214	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B44598	OTHER	MI	HAP ID
2	0824144	OTHER	MI	BLUE CARE NETWORK ID
3	C3390	OTHER	MI	M-CARE ID
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	126367	OTHER	MI	CARE CHOICES
6	080824144	OTHER	MI	BLUE CROSS BLUE SHIELD ID

General Provider Information

NPI Number	:	1033295167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CECELIA F. HISSONG, M. D., P. C.

Provider Business Mailing Address
First Line	:	23100 CHERRY HILL RD.
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-1493
Country	:	US
Telephone Number	:	313-563-5310
Fax Number	:	313-563-8147

Provider Business Practice Location Address
First Line	:	23100 CHERRY HILL RD.
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-1493
Country	:	US
Telephone Number	:	313-563-5310
Fax Number	:	313-563-8147

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CECELIA F. HISSONG
Credential	:	M. D.
Telephone Number	:	313-563-5310

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	12/22/2010

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