Healthcare Provider Details

I. General information

NPI: 1093266777
Provider Name (Legal Business Name): ASHTABULA SLEEP MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 STATE RD
ASHTABULA OH
44004-6265
US

IV. Provider business mailing address

5005 STATE RD
ASHTABULA OH
44004-6265
US

V. Phone/Fax

Practice location:
  • Phone: 440-992-3146
  • Fax: 440-998-6932
Mailing address:
  • Phone: 440-992-3146
  • Fax: 440-998-6932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL CRAIG SIVIK
Title or Position: GENERAL DENTIST, PRESIDENT, OWNER
Credential: D.M.D., F.I.C.O.I.
Phone: 440-992-3146