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General NPI Number Information
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NPI Number | 1164736005
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Entity Type | Organization
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Legal Business Name | VILLAGE SLEEP CENTER INC
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Dates
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Enumeration Date | 08/03/2010
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Last Update Date | 09/03/2010
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Provider Practice Location Address
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Address Line | 1100 LAKE ST STE LL40
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City | OAK PARK
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State | IL
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Zip | 60301-1066
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Country | US
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Telephone | 312-520-8547
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 LAKE ST STE LL40
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City | OAK PARK
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State | IL
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Zip | 60301-1066
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MIRCEA T IACOB
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Credential | MD
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Telephone | 312-520-8547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number | 036113093
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License Number State | IL
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