MEDICARE: SLEEP DIAGNOSTICE 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	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

General Provider Information

NPI Number	:	1629288055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLEEP DIAGNOSTICE CENTER LLC

Provider Business Mailing Address
First Line	:	5310 W CAPITOL DR STE 215
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2263
Country	:	US
Telephone Number	:	414-445-0400
Fax Number	:

Provider Business Practice Location Address
First Line	:	5310 W CAPITOL DR STE 215
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2263
Country	:	US
Telephone Number	:	414-445-0400
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MOHAMMAD K ALI
Credential	:
Telephone Number	:	414-445-0400

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	08/22/2020

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