Provider Demographics
NPI:1093853210
Name:MICHIGAN SLEEP SPECIALISTS
Entity Type:Organization
Organization Name:MICHIGAN SLEEP SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SOMMER
Authorized Official - Middle Name:CAMILLE
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:810-733-8338
Mailing Address - Street 1:G3237 BEECHER RD
Mailing Address - Street 2:M
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3695
Mailing Address - Country:US
Mailing Address - Phone:810-733-8338
Mailing Address - Fax:810-733-8023
Practice Address - Street 1:G3237 BEECHER RD
Practice Address - Street 2:M
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3695
Practice Address - Country:US
Practice Address - Phone:810-733-8338
Practice Address - Fax:810-733-8023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIEA069292174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4996410Medicaid
MI0P25090Medicare ID - Type UnspecifiedIDTF
MI0P25080Medicare ID - Type UnspecifiedIDTF