Provider Demographics
NPI:1912498148
Name:WOODBURY SLEEP SOLUTIONS PA
Entity Type:Organization
Organization Name:WOODBURY SLEEP SOLUTIONS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARKO
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-436-7559
Mailing Address - Street 1:2070 EAGLE CREEK LN STE 300
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-3218
Mailing Address - Country:US
Mailing Address - Phone:651-439-7559
Mailing Address - Fax:651-436-7553
Practice Address - Street 1:2070 EAGLE CREEK LN STE 300
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55129-3218
Practice Address - Country:US
Practice Address - Phone:651-439-7559
Practice Address - Fax:651-436-7553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12206122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No122300000XDental ProvidersDentistGroup - Multi-Specialty