Provider Demographics
NPI:1871510305
Name:MIDWEST SLEEP ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MIDWEST SLEEP ASSOCIATES, LLC
Other - Org Name:MIDWEST CENTER FOR SLEEP DISORDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALICKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-499-6682
Mailing Address - Street 1:2088 OGDEN AVE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-4376
Mailing Address - Country:US
Mailing Address - Phone:630-375-9499
Mailing Address - Fax:
Practice Address - Street 1:2088 OGDEN AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4376
Practice Address - Country:US
Practice Address - Phone:630-375-9499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWEST SLEEP ASSOCIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2232334OtherBLUE CROSS BLUE SHIELD
IL=========OtherTAX ID #
IL2232334OtherBLUE CROSS BLUE SHIELD