Provider Demographics
NPI:1578654950
Name:GRAND LAKE SLEEP CENTER
Entity Type:Organization
Organization Name:GRAND LAKE SLEEP CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAT
Authorized Official - Middle Name:BABU
Authorized Official - Last Name:KUCHIPUDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-394-9992
Mailing Address - Street 1:1040 HAGER ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2421
Mailing Address - Country:US
Mailing Address - Phone:419-394-9992
Mailing Address - Fax:419-394-9629
Practice Address - Street 1:1040 HAGER ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-2421
Practice Address - Country:US
Practice Address - Phone:419-394-9992
Practice Address - Fax:419-394-9629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic