Provider Demographics
NPI:1073818498
Name:NIGHT OWL DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:NIGHT OWL DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SARAFA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-579-5752
Mailing Address - Street 1:30095 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 20A
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3284
Mailing Address - Country:US
Mailing Address - Phone:248-579-5752
Mailing Address - Fax:248-479-8055
Practice Address - Street 1:30095 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 20A
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3284
Practice Address - Country:US
Practice Address - Phone:248-579-5752
Practice Address - Fax:248-479-8055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-15
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAE080821173F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173F00000XOther Service ProvidersSleep Specialist, PhDGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10600244Medicaid