Healthcare Provider Details

I. General information

NPI: 1396981460
Provider Name (Legal Business Name): INDIANA REGIONAL SLEEP DISORDER CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2008
Last Update Date: 03/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 S WABASH AVE
CHICAGO IL
60616-2955
US

IV. Provider business mailing address

55 E 86TH AVE PO BOX 10645
MERRILLVILLE IN
46410-6382
US

V. Phone/Fax

Practice location:
  • Phone: 219-944-4187
  • Fax: 219-944-4196
Mailing address:
  • Phone: 219-769-1670
  • Fax: 219-738-6714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036-119770
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036119770
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number036-119770
License Number StateIL

VIII. Authorized Official

Name: OLUSEGUN APATA
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 219-944-4187