MEDICARE: GREAT LAKES PULMONARY & SLEEP ASSOCIATES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	01064140	IN
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician	01064140	IN
3	207RP1001X	Pulmonary Disease Physician	01064140	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003096504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT LAKES PULMONARY & SLEEP ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	PO BOX 10068
Second Line	:
City	:	MERRILLVILLE
State	:	IN
Zip	:	46411-0068
Country	:	US
Telephone Number	:	219-882-0255
Fax Number	:	219-738-6714

Provider Business Practice Location Address
First Line	:	650 GRANT ST STE 7
Second Line	:
City	:	GARY
State	:	IN
Zip	:	46404-1551
Country	:	US
Telephone Number	:	219-882-0255
Fax Number	:	219-738-6714

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	OLUSEGUN APATA
Credential	:	MD
Telephone Number	:	219-882-0255

Provider Enumeration Date	:	11/13/2007
Last Update Date	:	07/10/2012

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