Provider Demographics
NPI:1710923313
Name:WELLPOINTE SLEEP DIAGNOSTIC CENTER LLC
Entity Type:Organization
Organization Name:WELLPOINTE SLEEP DIAGNOSTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:B
Authorized Official - Last Name:KERR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-755-5522
Mailing Address - Street 1:18223 E 10 MILE RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-5821
Mailing Address - Country:US
Mailing Address - Phone:586-260-7301
Mailing Address - Fax:586-948-3804
Practice Address - Street 1:1701 SOUTH BOULEVARD EAST
Practice Address - Street 2:SUITE B 25
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307
Practice Address - Country:US
Practice Address - Phone:248-465-1848
Practice Address - Fax:248-380-8620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIB8178Y261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic