Healthcare Provider Details

I. General information

NPI: 1770676900
Provider Name (Legal Business Name): MHNI SLEEP MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 PROFESSIONAL DR SLEEP MEDICINE
ANN ARBOR MI
48104-5131
US

IV. Provider business mailing address

3120 PROFESSIONAL DR SLEEP MEDICINE
ANN ARBOR MI
48104-5131
US

V. Phone/Fax

Practice location:
  • Phone: 734-677-6000
  • Fax: 734-677-2422
Mailing address:
  • Phone: 734-677-6000
  • Fax: 734-677-2422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SCOTT F MADDEN
Title or Position: VICE PRESIDENT & ADMINISTRATOR
Credential: FACHE
Phone: 734-677-6000