Provider Demographics
NPI:1467673939
Name:ELK KALAMAZOO, LLC
Entity Type:Organization
Organization Name:ELK KALAMAZOO, LLC
Other - Org Name:KALAMAZOO SLEEP CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO, MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LATOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-327-7146
Mailing Address - Street 1:2340 E CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-4465
Mailing Address - Country:US
Mailing Address - Phone:269-327-7146
Mailing Address - Fax:269-327-7196
Practice Address - Street 1:2340 E CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-4465
Practice Address - Country:US
Practice Address - Phone:269-327-7146
Practice Address - Fax:269-327-7196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION97060Medicare ID - Type UnspecifiedIDTF PROVIDER #