Provider Demographics
NPI:1871532705
Name:PROPHIT, CECILIA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:MARIE
Last Name:PROPHIT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CECILIA
Other - Middle Name:MARIE
Other - Last Name:PROPHIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE M273
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-381-0180
Mailing Address - Fax:269-381-7347
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M273
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-381-0180
Practice Address - Fax:269-381-7347
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059008207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
155429OtherGREAT LAKES HLTH PLN
MI3011204-10Medicaid
5020219OtherAETNA PIN
MI3403902650OtherBCBS IND PIN
MI040C910710OtherBCBS GRP PIN
MI3403902650OtherBCBS IND PIN
MI040008154Medicare PIN
F22396Medicare UPIN
MI3011204-10Medicaid
MIC15823Medicare PIN