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General NPI Number Information
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NPI Number | 1841344702
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Entity Type | Organization
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Legal Business Name | MICHIANA REGIONAL SLEEP DISORDERS CENTER P.C.
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 04/23/2008
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Provider Practice Location Address
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Address Line | 3902 STONEGATE PARK
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-9130
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Country | US
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Telephone | 269-983-3690
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Fax | 269-982-5101
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Provider Business Mailing Address
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Address Line | 3902 STONEGATE PARK
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-9130
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Country | US
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Telephone | 269-983-3690
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Fax | 269-982-5101
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT L. PIASECKI
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Credential | DO
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Telephone | 269-983-3690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0012X
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Taxonomy Name | Sleep Medicine (Otolaryngology) Physician
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License Number | 4301070920
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2084S0012X
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Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
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License Number | 5101009750
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | 5101008659
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License Number State | MI
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