Provider Demographics
NPI:1235997800
Name:CENTER FOR SLEEP AND NASAL SINUS DISORDERS, LLC
Entity Type:Organization
Organization Name:CENTER FOR SLEEP AND NASAL SINUS DISORDERS, LLC
Other - Org Name:ADVENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MADAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:KANDULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-938-3838
Mailing Address - Street 1:10001 W INNOVATION DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4851
Mailing Address - Country:US
Mailing Address - Phone:888-938-3838
Mailing Address - Fax:888-919-1083
Practice Address - Street 1:7388 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6973
Practice Address - Country:US
Practice Address - Phone:888-938-3838
Practice Address - Fax:888-919-1083
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR SLEEP AND NASAL SINUS DISORDERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-08
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300086469Medicaid
IN300086350Medicaid