Provider Demographics
NPI:1417350026
Name:CISNEROS-GONZALEZ, LIGIA ELENA (MD)
Entity Type:Individual
Prefix:
First Name:LIGIA
Middle Name:ELENA
Last Name:CISNEROS-GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 W BETHUNE ST APT 1709
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2666
Mailing Address - Country:US
Mailing Address - Phone:734-548-2425
Mailing Address - Fax:
Practice Address - Street 1:1350 W BETHUNE ST APT 1709
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2666
Practice Address - Country:US
Practice Address - Phone:734-548-2425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-28
Last Update Date:2014-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301104902207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology