Provider Demographics
NPI:1770717431
Name:INSTITUTE OF SLEEP & WELLNESS LLC
Entity type:Organization
Organization Name:INSTITUTE OF SLEEP & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MINICUCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-263-8144
Mailing Address - Street 1:15930 19 MILE RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1155
Mailing Address - Country:US
Mailing Address - Phone:586-263-8144
Mailing Address - Fax:586-263-8155
Practice Address - Street 1:24361 GREENFIELD RD
Practice Address - Street 2:SUITE 209
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3139
Practice Address - Country:US
Practice Address - Phone:248-443-8487
Practice Address - Fax:586-263-8155
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INSTITUTE OF SLEEP & WELLNESS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301405226261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic