Provider Demographics
NPI:1083768451
Name:MICHIANA REGIONAL SLEEP DISORDERS CENTER P.C.
Entity Type:Organization
Organization Name:MICHIANA REGIONAL SLEEP DISORDERS CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:PIASECKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:269-983-3690
Mailing Address - Street 1:3902 STONEGATE PARK
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9130
Mailing Address - Country:US
Mailing Address - Phone:269-983-3690
Mailing Address - Fax:269-982-5101
Practice Address - Street 1:3902 STONEGATE PARK
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9130
Practice Address - Country:US
Practice Address - Phone:269-983-3690
Practice Address - Fax:269-982-5101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540A11082OtherBCBSM DME
MI540A11082OtherBCBSM DME