MEDICARE: SLEEP AND BEHAVIOR MEDICINE INSTITUTE

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	2084P0800X	Psychiatry Physician	036067800	IL
2	261QS1200X	Sleep Disorder Diagnostic Clinic/Center	036-067800	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31601717	OTHER	IL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902962350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLEEP AND BEHAVIOR MEDICINE INSTITUTE

Provider Business Mailing Address
First Line	:	565 LAKEVIEW PARKWAY
Second Line	:	SUITE 105
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-1840
Country	:	US
Telephone Number	:	847-984-6585
Fax Number	:	847-984-6586

Provider Business Practice Location Address
First Line	:	565 LAKEVIEW PARKWAY
Second Line	:	SUITE 105
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-1840
Country	:	US
Telephone Number	:	847-984-6585
Fax Number	:	847-984-6586

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	MR. ALEXANDER Z GOLBIN
Credential	:	MD
Telephone Number	:	847-984-6585

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	05/13/2013

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Directions to “SLEEP AND BEHAVIOR MEDICINE INSTITUTE ” Practice Location

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