Provider Demographics
NPI:1003096504
Name:GREAT LAKES PULMONARY & SLEEP ASSOCIATES, INC
Entity Type:Organization
Organization Name:GREAT LAKES PULMONARY & SLEEP ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLUSEGUN
Authorized Official - Middle Name:
Authorized Official - Last Name:APATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-882-0255
Mailing Address - Street 1:PO BOX 10068
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46411-0068
Mailing Address - Country:US
Mailing Address - Phone:219-882-0255
Mailing Address - Fax:219-738-6714
Practice Address - Street 1:650 GRANT ST STE 7
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-1551
Practice Address - Country:US
Practice Address - Phone:219-882-0255
Practice Address - Fax:219-738-6714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064140207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200881250AMedicaid
IN245540Medicare PIN
WIF94947Medicare UPIN
IN200881250AMedicaid