Healthcare Provider Details

I. General information

NPI: 1396053344
Provider Name (Legal Business Name): SLEEP SERVICES OF WISCONSIN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 01/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2356 S 102ND ST SUITE B
WEST ALLIS WI
53227-2104
US

IV. Provider business mailing address

2356 S 102ND ST SUITE B
WEST ALLIS WI
53227-2104
US

V. Phone/Fax

Practice location:
  • Phone: 414-336-3000
  • Fax: 414-336-1015
Mailing address:
  • Phone: 414-336-3000
  • Fax: 414-336-1015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: VERNON R BAAKE
Title or Position: CEO
Credential:
Phone: 414-336-3000