Individual
CECILLY A PRATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
15959 HALL RD STE 104, MACOMB, MI 48044
(586) 884-2688
(586) 566-1674
Mailing address
15959 HALL RD STE 104, MACOMB, MI 48044-5364
(586) 884-2688
(586) 566-1674
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4301078472
MI
208D00000X
General Practice Physician
Primary
069696
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
464270910
—
MI
01
—
700E012740
BCBSM GROUP NUMBER
MI
Enumeration date
04/21/2006
Last updated
09/04/2018
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