Provider Demographics
NPI:1942468780
Name:WOLVERINE SLEEP PLLC
Entity Type:Organization
Organization Name:WOLVERINE SLEEP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:GORCZYCA
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:517-424-8286
Mailing Address - Street 1:411 E RUSSELL RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-7502
Mailing Address - Country:US
Mailing Address - Phone:517-424-8286
Mailing Address - Fax:517-470-0296
Practice Address - Street 1:23353 US HWY 82 W
Practice Address - Street 2:SUITE 2
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092
Practice Address - Country:US
Practice Address - Phone:903-786-2621
Practice Address - Fax:903-786-2634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PL7268OtherBCBS OF TEXAS
PL7268OtherBCBS OF TEXAS
TXFTSP45Medicare PIN