Provider Demographics
NPI:1265477897
Name:MIDWEST SLEEP ASSOCIATES, LLC.
Entity Type:Organization
Organization Name:MIDWEST SLEEP ASSOCIATES, LLC.
Other - Org Name:MIDWEST CENTER FOR SLEEP DISORDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALICKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-499-6682
Mailing Address - Street 1:88 W COUNTRYSIDE PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-2010
Mailing Address - Country:US
Mailing Address - Phone:630-375-9499
Mailing Address - Fax:
Practice Address - Street 1:88 W COUNTRYSIDE PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-2010
Practice Address - Country:US
Practice Address - Phone:630-375-9499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWEST SLEEP ASSOCIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
2232334OtherBLUE CROSS BLUE SHIELD
2232334OtherBLUE CROSS BLUE SHIELD
207959Medicare ID - Type Unspecified