Healthcare Provider Details

I. General information

NPI: 1225079171
Provider Name (Legal Business Name): PLEASANT DREAMS SLEEP CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 12/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 S MISSION ST SUITE 24
MT PLEASANT MI
48858-3939
US

IV. Provider business mailing address

PO BOX 903
WEST BRANCH MI
48661-0903
US

V. Phone/Fax

Practice location:
  • Phone: 989-775-0205
  • Fax: 989-345-3514
Mailing address:
  • Phone: 989-345-2068
  • Fax: 989-345-5803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4301072871
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT R KILE
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 989-345-3408