Provider Demographics
NPI:1083216220
Name:SIGUE, ISSOUF
Entity type:Individual
Prefix:
First Name:ISSOUF
Middle Name:
Last Name:SIGUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 E DAYTON YELLOW SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-6432
Mailing Address - Country:US
Mailing Address - Phone:347-208-8786
Mailing Address - Fax:
Practice Address - Street 1:534 E DAYTON YELLOW SPRINGS RD
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-6432
Practice Address - Country:US
Practice Address - Phone:347-208-8786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker