Provider Demographics
NPI:1396053344
Name:SLEEP SERVICES OF WISCONSIN, LLC
Entity type:Organization
Organization Name:SLEEP SERVICES OF WISCONSIN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:R
Authorized Official - Last Name:BAAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-336-3000
Mailing Address - Street 1:2356 S 102ND ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2104
Mailing Address - Country:US
Mailing Address - Phone:414-336-3000
Mailing Address - Fax:414-336-1015
Practice Address - Street 1:2356 S 102ND ST
Practice Address - Street 2:SUITE B
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2104
Practice Address - Country:US
Practice Address - Phone:414-336-3000
Practice Address - Fax:414-336-1015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic