Healthcare Provider Details

I. General information

NPI: 1245713338
Provider Name (Legal Business Name): SURGICAL SLEEP SPECIALIST, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W MAPLE ST
HINSDALE IL
60521-3227
US

IV. Provider business mailing address

306 W MAPLE ST
HINSDALE IL
60521-3227
US

V. Phone/Fax

Practice location:
  • Phone: 312-961-3875
  • Fax: 708-364-0269
Mailing address:
  • Phone: 312-961-3875
  • Fax: 708-364-0269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT D THOMAS
Title or Position: PRESIDENT
Credential: MD
Phone: 312-961-3875