Healthcare Provider Details

I. General information

NPI: 1093458333
Provider Name (Legal Business Name): TROY CISNEROS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E MEDICAL CENTER DR SPC 5845
ANN ARBOR MI
48109-5845
US

IV. Provider business mailing address

1500 E MEDICAL CENTER DR SPC 5845
ANN ARBOR MI
48109-5845
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-9068
  • Fax:
Mailing address:
  • Phone: 734-936-9068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number4351053804
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: