Provider Demographics
NPI:1053554469
Name:MICHIGAN SLEEP DIAGNOSTIC CENTER, LLC
Entity type:Organization
Organization Name:MICHIGAN SLEEP DIAGNOSTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANGASWAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:PRAKASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-917-7835
Mailing Address - Street 1:2000 SPRING ARBOR RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-2887
Mailing Address - Country:US
Mailing Address - Phone:517-962-5220
Mailing Address - Fax:517-962-5221
Practice Address - Street 1:2000 SPRING ARBOR RD
Practice Address - Street 2:SUITE B
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-2887
Practice Address - Country:US
Practice Address - Phone:517-962-5220
Practice Address - Fax:517-962-5221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1053554469Medicaid
0C80005OtherBCBS
MI2023Medicare PIN