Healthcare Provider Details

I. General information

NPI: 1881707891
Provider Name (Legal Business Name): HOME SLEEP DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2522 W PETERSON AVE
CHICAGO IL
60659-4109
US

IV. Provider business mailing address

2522 W PETERSON AVE
CHICAGO IL
60659-4109
US

V. Phone/Fax

Practice location:
  • Phone: 773-262-4110
  • Fax: 773-784-0701
Mailing address:
  • Phone: 773-262-4110
  • Fax: 773-784-0701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. AHUVA ELANA SHABAT
Title or Position: PRESIDENT
Credential:
Phone: 773-262-4110