Healthcare Provider Details

I. General information

NPI: 1801291315
Provider Name (Legal Business Name): PROGRESSIVE SLEEP, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 FRANK LLOYD WRIGHT DRIVE LOBBY A
ANN ARBOR MI
48106-0326
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DRIVE LOBBY A
ANN ARBOR MI
48106-0326
US

V. Phone/Fax

Practice location:
  • Phone: 734-930-4022
  • Fax: 734-930-4029
Mailing address:
  • Phone: 734-930-4022
  • Fax: 734-930-4029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901017411
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301096549
License Number StateMI

VIII. Authorized Official

Name: MERIDITH L HALL
Title or Position: MEMBER
Credential: DDS
Phone: 734-930-4022