Provider Demographics
NPI:1912074147
Name:SOUTH CHICAGO SLEEP LAB, INC.
Entity Type:Organization
Organization Name:SOUTH CHICAGO SLEEP LAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:BISLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-955-8084
Mailing Address - Street 1:512 N MCCLURG CT
Mailing Address - Street 2:#3207
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5359
Mailing Address - Country:US
Mailing Address - Phone:312-545-7425
Mailing Address - Fax:
Practice Address - Street 1:9011 S COMMERCIAL AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-4304
Practice Address - Country:US
Practice Address - Phone:773-375-1845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1769484261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1636864OtherBCBS
IL214836Medicare PIN