MEDICARE: EUGENIA B CISSOKO I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide	C220237007746	MI

General Provider Information

NPI Number	:	1669323754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENIA B CISSOKO I

Provider Business Mailing Address
First Line	:	23251 FLORENCE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48219-3719
Country	:	US
Telephone Number	:	248-974-3917
Fax Number	:

Provider Business Practice Location Address
First Line	:	23251 FLORENCE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48219-3719
Country	:	US
Telephone Number	:	248-974-3917
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	02/05/2026

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Directions to “ EUGENIA B CISSOKO I ” Practice Location

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