MEDICARE: SOUND SLEEP CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS1200X	Sleep Disorder Diagnostic Clinic/Center	036094416	IL

General Provider Information

NPI Number	:	1598085706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUND SLEEP CENTER INC

Provider Business Mailing Address
First Line	:	10210 WICKER AVENUE
Second Line	:	SUITE 4
City	:	SAINT JOHN
State	:	IN
Zip	:	46373
Country	:	US
Telephone Number	:	219-775-7722
Fax Number	:	708-221-6603

Provider Business Practice Location Address
First Line	:	1600 S. TORRENCE AVENUE
Second Line	:	LOWER LEVEL
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-5430
Country	:	US
Telephone Number	:	708-730-1750
Fax Number	:	708-915-4897

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WOJCIECH ORNOWSKI
Credential	:	M.D.
Telephone Number	:	773-528-1218

Provider Enumeration Date	:	06/10/2010
Last Update Date	:	06/10/2010

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