Healthcare Provider Details

I. General information

NPI: 1184670564
Provider Name (Legal Business Name): MIDWEST CENTER FOR SLEEP DISORDERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10415 GRAND RIVER RD STE 500
BRIGHTON MI
48116-6535
US

IV. Provider business mailing address

101 E SPICERVILLE HWY
EATON RAPIDS MI
48827-1919
US

V. Phone/Fax

Practice location:
  • Phone: 810-225-7595
  • Fax: 810-225-7597
Mailing address:
  • Phone: 517-663-9469
  • Fax: 517-663-9470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberAG048680
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberCG043420
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberAA058590
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ASHOK K GUPTA
Title or Position: CO-OWNER
Credential: MD
Phone: 517-663-9469