Provider Demographics
NPI:1114029030
Name:NEUROSLEEP CENTER PLLC
Entity Type:Organization
Organization Name:NEUROSLEEP CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:TURK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-216-1901
Mailing Address - Street 1:4190 24TH AVE,
Mailing Address - Street 2:STE # 210
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059
Mailing Address - Country:US
Mailing Address - Phone:810-216-1901
Mailing Address - Fax:810-216-1701
Practice Address - Street 1:4190 24TH AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-3882
Practice Address - Country:US
Practice Address - Phone:810-216-1901
Practice Address - Fax:810-216-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIOT0807682084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI270H237980OtherBCBS OF MI
MI4850523Medicaid
MI4850523Medicaid
MII50684Medicare UPIN