MEDICARE: PLEASANT DREAMS SLEEP CENTER 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	2084N0400X	Neurology Physician	4301072871	MI
2	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4301072871	OTHER	MI	LICENSE
2	1134100175	OTHER	MI	NPI

General Provider Information

NPI Number	:	1225079171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLEASANT DREAMS SLEEP CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 903
Second Line	:
City	:	WEST BRANCH
State	:	MI
Zip	:	48661-0903
Country	:	US
Telephone Number	:	989-345-2068
Fax Number	:	989-345-5803

Provider Business Practice Location Address
First Line	:	1205 S MISSION ST
Second Line	:	SUITE 24
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-3939
Country	:	US
Telephone Number	:	989-775-0205
Fax Number	:	989-345-3514

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	ROBERT R KILE
Credential	:
Telephone Number	:	989-345-3408

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	12/30/2011

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