Provider Demographics
NPI:1033106059
Name:ADVANCED SLEEP CENTER
Entity Type:Organization
Organization Name:ADVANCED SLEEP CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GAVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AWERBUCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-773-1823
Mailing Address - Street 1:1159 E MICHIGAN AVE
Mailing Address - Street 2:STE D
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-5807
Mailing Address - Country:US
Mailing Address - Phone:586-773-1823
Mailing Address - Fax:586-773-1211
Practice Address - Street 1:1159 E MICHIGAN AVE
Practice Address - Street 2:STE D
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-5807
Practice Address - Country:US
Practice Address - Phone:586-773-1823
Practice Address - Fax:586-773-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGA4052276247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4618122Medicaid
MIB43959Medicare UPIN
MI0N87860Medicare ID - Type UnspecifiedYPSI MEDICARE GROUP
MIN87860001Medicare PIN