Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 036-108497 | IL |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 4301407270 | MI |
NPI | 1003004524 |
---|---|
Provider Name | Dr. Christine Marie Cisneros |
First Address | Ann Arbor, MI 48104-6462 |
Second Address | Elkhart, IN 46514-3366 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2007 |
Last Update Date | 29/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
700H231390 | BCBSM GROUP NUMBER (01) | MI |