Healthcare Provider Details

I. General information

NPI: 1235997800
Provider Name (Legal Business Name): CENTER FOR SLEEP AND NASAL SINUS DISORDERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 09/02/2025
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7388 BUSINESS CENTER DR
AVON IN
46123-6973
US

IV. Provider business mailing address

10001 W INNOVATION DR STE 200
MILWAUKEE WI
53226-4851
US

V. Phone/Fax

Practice location:
  • Phone: 888-938-3838
  • Fax: 888-919-1083
Mailing address:
  • Phone: 888-938-3838
  • Fax: 888-919-1083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: MADAN N KANDULA
Title or Position: CEO
Credential: MD
Phone: 888-938-3838