Provider Demographics
NPI:1801966080
Name:SLEEP APNEA SPECIALTY CENTER
Entity type:Organization
Organization Name:SLEEP APNEA SPECIALTY CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED SIGNER
Authorized Official - Prefix:
Authorized Official - First Name:RAVINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:GANDHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-285-4145
Mailing Address - Street 1:14031 PENNSYLVANIA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-7508
Mailing Address - Country:US
Mailing Address - Phone:734-285-4145
Mailing Address - Fax:734-285-4451
Practice Address - Street 1:14031 PENNSYLVANIA RD
Practice Address - Street 2:SUITE A
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-7508
Practice Address - Country:US
Practice Address - Phone:734-285-4145
Practice Address - Fax:734-285-4451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104947407Medicaid
MI290H229410OtherBCBSM
=========OtherTAX ID
=========OtherTAX ID
MI0P43010Medicare PIN