Healthcare Provider Details

I. General information

NPI: 1093411191
Provider Name (Legal Business Name): SLIIIP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N MICHIGAN AVE STE 1200
CHICAGO IL
60611-4264
US

IV. Provider business mailing address

1140 S JACKSON SPRINGS RD # GA
MACON GA
31211-1439
US

V. Phone/Fax

Practice location:
  • Phone: 478-238-3552
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: AVINESH SINGH BHAR JASWINDAR SINGH
Title or Position: OWNER
Credential:
Phone: 478-238-3552