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General NPI Number Information
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NPI Number | 1104349216
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Entity Type | Organization
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Legal Business Name | LOUISVILLE SLEEP LAB LLC
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Dates
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Enumeration Date | 07/20/2017
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Last Update Date | 07/20/2017
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Provider Practice Location Address
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Address Line | 1015 DUPONT RD
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City | LOUISVILLE
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State | KY
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Zip | 40207-4610
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Country | US
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Telephone | 904-234-0766
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Fax | 502-410-0484
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Provider Business Mailing Address
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Address Line | 5810 HARRODS GLEN DR
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City | PROSPECT
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State | KY
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Zip | 40059-7650
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Country | US
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Telephone | 904-234-0766
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Fax | 502-410-0484
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | SAJJAD JAMEEL
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Credential | MD
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Telephone | 904-234-0766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | 39870
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License Number State | KY
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