Christine Marie Cisneros, M.D.
Individual provider Active NPI Occupational Medicine Physician · Elkhart, IN
NPI 1003004524 · NPPES record last updated Jul 29, 2012
Key facts
- NPI
- 1003004524
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Medicine Physician 2083X0100X
- License
- 4301407270 (MI)
- Practice address
- 700 E Beardsley Ave
Ste 100
Elkhart, IN 46514-3366 - Phone
- (574) 206-8010
- NPI assigned
- Oct 10, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-108497 | IL | MD | Neuromusculoskeletal Medicine & OMM Physician |
| 4301407270 | MI | MD | Occupational Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Provena Hospitals | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neuromusculoskeletal Medicine & OMM Physician | 204D00000X | 4301407270 | MI | |
| Neuromusculoskeletal Medicine & OMM Physician | 204D00000X | 036-108497 | IL | |
| Occupational Medicine Physician | 2083X0100X | 4301407270 | MI | Yes |
Addresses
Primary practice location
700 E Beardsley Ave
Ste 100
Elkhart, IN 46514-3366
Mailing address
2760 Ember Way
Ann Arbor, MI 48104-6462
Phone (734) 913-0949
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 700H231390 | Other | MI | BCBSM GROUP NUMBER |
Other providers in Elkhart, IN
- Pamela Sue Chubb
- John Chung
- Deanna Chupp
- Amelia Chuppe
- Mary Ann Cintron
- City of Elkhart
- City of Elkhart
- City Optical Co., Inc.
- Elizabeth Ciupinski
- Meghan Clairday
All providers in Elkhart, IN · Occupational Medicine Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 29, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.