MEDICARE: DREAM SLEEP TESTING LLC

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	246Z00000X	Other Specialist/Technologist	17293

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0Z90246	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1114303187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DREAM SLEEP TESTING LLC

Provider Business Mailing Address
First Line	:	4439 PINE MEADOWS TRL
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49685-7386
Country	:	US
Telephone Number	:	231-642-5124
Fax Number	:

Provider Business Practice Location Address
First Line	:	4439 PINE MEADOWS TRL
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49685-7386
Country	:	US
Telephone Number	:	231-642-5124
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JUSTIN DONAGHY
Credential	:	CRT
Telephone Number	:	231-642-5124

Provider Enumeration Date	:	07/31/2015
Last Update Date	:	02/10/2021

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