Provider Demographics
NPI:1376720987
Name:NORTHSHORE RESPIRATORY AND SLEEP
Entity Type:Organization
Organization Name:NORTHSHORE RESPIRATORY AND SLEEP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:F
Authorized Official - Last Name:KOWALSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-954-9388
Mailing Address - Street 1:1450 SOM CENTER RD
Mailing Address - Street 2:#25
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2118
Mailing Address - Country:US
Mailing Address - Phone:440-446-1423
Mailing Address - Fax:440-446-1498
Practice Address - Street 1:4212 STATE ROUTE 306
Practice Address - Street 2:#110
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-9258
Practice Address - Country:US
Practice Address - Phone:440-954-9388
Practice Address - Fax:440-269-1338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE29842Medicare UPIN
OH9373471Medicare PIN