Provider Demographics
NPI:1265690408
Name:SLEEPY FOX LLC
Entity Type:Organization
Organization Name:SLEEPY FOX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:BENADERET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-206-0985
Mailing Address - Street 1:3055 KETTERING BLVD
Mailing Address - Street 2:SUITE 219-B
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1900
Mailing Address - Country:US
Mailing Address - Phone:800-235-3138
Mailing Address - Fax:937-395-4415
Practice Address - Street 1:15855 19 MILE ROAD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-3504
Practice Address - Country:US
Practice Address - Phone:800-235-3138
Practice Address - Fax:937-395-4415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301043632207RC0000X
MI4301033593207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty