Provider Demographics
NPI:1700030731
Name:SOUTHWEST INSTITUTE FOR SLEEP
Entity Type:Organization
Organization Name:SOUTHWEST INSTITUTE FOR SLEEP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HADDAR
Authorized Official - Middle Name:E
Authorized Official - Last Name:ICHILOV
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:602-439-3800
Mailing Address - Street 1:15640 N 7TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-3512
Mailing Address - Country:US
Mailing Address - Phone:602-439-3800
Mailing Address - Fax:
Practice Address - Street 1:15640 N 7TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-3512
Practice Address - Country:US
Practice Address - Phone:602-439-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Single Specialty