Provider Demographics
NPI:1093107682
Name:MICHIGAN HEALTHCARE PROFESSIONALS
Entity Type:Organization
Organization Name:MICHIGAN HEALTHCARE PROFESSIONALS
Other - Org Name:SLEEP DISORDER CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASS SECRETARY OF CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHAELENE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOGOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-851-1430
Mailing Address - Street 1:29992 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3292
Mailing Address - Country:US
Mailing Address - Phone:248-851-1430
Mailing Address - Fax:248-851-5182
Practice Address - Street 1:29245 RYAN RD
Practice Address - Street 2:SUITE 400
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-4284
Practice Address - Country:US
Practice Address - Phone:586-576-0106
Practice Address - Fax:586-576-0235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic