1457739534 NPI number — COMPREHENSIVE SLEEP DIAGNOSTICS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457739534 NPI number — COMPREHENSIVE SLEEP DIAGNOSTICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE SLEEP DIAGNOSTICS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457739534
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18268 PARKSHORE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHVILLE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48168-8588
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-755-6888
Provider Business Mailing Address Fax Number:
517-657-7759

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3515 COOLIDGE RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48823-8014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-755-6222
Provider Business Practice Location Address Fax Number:
888-501-3585
Provider Enumeration Date:
05/11/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MAMEDOV
Authorized Official First Name:
OKTAI
Authorized Official Middle Name:
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
443-248-1877

Provider Taxonomy Codes

  • Taxonomy code: 207RS0012X , with the licence number:  4301096000 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1457739534 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0C30925 . This is a "BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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