Healthcare Provider Details

I. General information

NPI: 1225401599
Provider Name (Legal Business Name): MICHIGAN SLEEP SOCIETY & RESEARCH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

G3285 BEECHER RD
FLINT MI
48532-3615
US

IV. Provider business mailing address

G3285 BEECHER RD SUITE M
FLINT MI
48532-3615
US

V. Phone/Fax

Practice location:
  • Phone: 810-874-8384
  • Fax: 810-733-8023
Mailing address:
  • Phone: 810-733-8338
  • Fax: 810-733-8023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License NumberE7374T
License Number StateMI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. SOMMER CAMILLE GREEN
Title or Position: PRESIDENT
Credential: MPA
Phone: 810-733-8338