Provider Demographics
NPI:1326211715
Name:CLINICAL NEUROPHYSIOLOGY SERVICES, PC
Entity Type:Organization
Organization Name:CLINICAL NEUROPHYSIOLOGY SERVICES, PC
Other - Org Name:SLEEP & ATTENTION DISORDERS INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:R
Authorized Official - Middle Name:BART
Authorized Official - Last Name:SANGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-254-0707
Mailing Address - Street 1:44344 DEQUINDRE RD STE 360
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1041
Mailing Address - Country:US
Mailing Address - Phone:586-254-0707
Mailing Address - Fax:
Practice Address - Street 1:44344 DEQUINDRE RD STE 360
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1041
Practice Address - Country:US
Practice Address - Phone:586-254-0707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010462112084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI085738OtherHEALTH ALLIANCE PLAN
MI130E003300OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI130E003300OtherBLUE CARE NETWORK
MI1790771Medicaid
MI0E03827OtherBLUE CROSS BLUE SHIELD OF MI
MI085738OtherHEALTH ALLIANCE PLAN
MI0E03827OtherBLUE CROSS BLUE SHIELD OF MI
MI130E003300OtherBLUE CROSS BLUE SHIELD OF MICHIGAN