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General NPI Number Information
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NPI Number | 1952541922
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Entity Type | Organization
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Legal Business Name | NORTHERN ILLINOIS SLEEP CENTER, S.C
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Dates
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Enumeration Date | 03/03/2009
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Last Update Date | 03/03/2009
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Provider Practice Location Address
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Address Line | 1958 ABERDEEN CT SUITE 2
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City | SYCAMORE
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State | IL
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Zip | 60178-3175
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Country | US
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Telephone | 815-787-7997
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Fax | 815-316-7897
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Provider Business Mailing Address
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Address Line | PO BOX 5023
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City | ROCKFORD
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State | IL
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Zip | 61125-0023
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Country | US
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Telephone | 815-316-1899
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Fax | 815-316-1897
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. VIVEK THAPPA
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Credential | M.D.
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Telephone | 815-316-1899
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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 | 036081657
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License Number State | IL
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