Provider Demographics
NPI:1578634440
Name:SLEEP APNEA SPECIALTY CENTERS OF
Entity Type:Organization
Organization Name:SLEEP APNEA SPECIALTY CENTERS OF
Other - Org Name:SLEEP APNEA SPECIALTY CENTERS OF MICHIGAN, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED SIGNER
Authorized Official - Prefix:
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:VICTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-844-6042
Mailing Address - Street 1:42180 FORD RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3673
Mailing Address - Country:US
Mailing Address - Phone:734-844-6042
Mailing Address - Fax:
Practice Address - Street 1:42180 FORD RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3673
Practice Address - Country:US
Practice Address - Phone:734-844-6042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N78510Medicare ID - Type Unspecified