Healthcare Provider Details

I. General information

NPI: 1487692893
Provider Name (Legal Business Name): MIDWEST SLEEP LAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5702 W 95TH ST
OAK LAWN IL
60453-2345
US

IV. Provider business mailing address

5702 W 95TH ST
OAK LAWN IL
60453-2345
US

V. Phone/Fax

Practice location:
  • Phone: 708-423-9982
  • Fax: 708-423-9984
Mailing address:
  • Phone: 708-423-9982
  • Fax: 708-423-9984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name: SULTAN TAHER
Title or Position: OWNER
Credential:
Phone: 708-423-9982