Healthcare Provider Details

I. General information

NPI: 1700160074
Provider Name (Legal Business Name): SLEEP HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

581 SULLIVAN RD STE B
AURORA IL
60506-1492
US

IV. Provider business mailing address

581 SULLIVAN RD STE B
AURORA IL
60506-1492
US

V. Phone/Fax

Practice location:
  • Phone: 630-844-1300
  • Fax: 630-844-1345
Mailing address:
  • Phone: 630-844-1300
  • Fax: 630-844-1345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. MOHAMMED A MAHKRI
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 630-906-7100