Provider Demographics
NPI:1912952706
Name:SLEEP DISORDER INSTITUTE OF NORTHWEST INDIANA LLC
Entity Type:Organization
Organization Name:SLEEP DISORDER INSTITUTE OF NORTHWEST INDIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:L
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-263-7255
Mailing Address - Street 1:6040 LUTE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-5008
Mailing Address - Country:US
Mailing Address - Phone:219-764-4567
Mailing Address - Fax:219-764-4566
Practice Address - Street 1:6040 LUTE RD
Practice Address - Street 2:SUITE A
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-5008
Practice Address - Country:US
Practice Address - Phone:219-764-4567
Practice Address - Fax:219-764-4566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2005040400231247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty