Provider Demographics
NPI:1093266777
Name:ASHTABULA SLEEP MEDICINE LLC
Entity Type:Organization
Organization Name:ASHTABULA SLEEP MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST, PRESIDENT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:SIVIK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, FICOI
Authorized Official - Phone:440-992-3146
Mailing Address - Street 1:5005 STATE RD
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-6265
Mailing Address - Country:US
Mailing Address - Phone:440-992-3146
Mailing Address - Fax:440-998-6932
Practice Address - Street 1:5005 STATE RD
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6265
Practice Address - Country:US
Practice Address - Phone:440-992-3146
Practice Address - Fax:440-998-6932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-022904122300000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No122300000XDental ProvidersDentistGroup - Single Specialty