Provider Demographics
NPI:1184670564
Name:MIDWEST CENTER FOR SLEEP DISORDERS LLC
Entity Type:Organization
Organization Name:MIDWEST CENTER FOR SLEEP DISORDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHOK
Authorized Official - Middle Name:K
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-663-9469
Mailing Address - Street 1:101 E SPICERVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:EATON RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:48827-1919
Mailing Address - Country:US
Mailing Address - Phone:517-663-9469
Mailing Address - Fax:517-663-9470
Practice Address - Street 1:10415 GRAND RIVER RD
Practice Address - Street 2:STE 500
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-6535
Practice Address - Country:US
Practice Address - Phone:810-225-7595
Practice Address - Fax:810-225-7597
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWEST CENTER FOR SLEEP DISORDERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-26
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAG048680207RS0012X
MICG043420207RS0012X
MIAA058590207RS0012X
261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N83100Medicare PIN