Healthcare Provider Details

I. General information

NPI: 1235177635
Provider Name (Legal Business Name): RENAISSANCE SLEEP AND DIAGNOSTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 11/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 WOOLEY RD
OXFORD MI
48371-3325
US

IV. Provider business mailing address

1325 WOOLEY RD
OXFORD MI
48371-3325
US

V. Phone/Fax

Practice location:
  • Phone: 248-613-1300
  • Fax:
Mailing address:
  • Phone: 248-613-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number StateMI

VIII. Authorized Official

Name: MRS. KATHLEEN RENE LUCIANO
Title or Position: OWNER
Credential: RRT
Phone: 248-613-1300