Provider Demographics
NPI:1295906741
Name:GREAT LAKES SLEEP MEDICINE INSTITUTE PLC
Entity type:Organization
Organization Name:GREAT LAKES SLEEP MEDICINE INSTITUTE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YEVGENIY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEFADU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-268-0100
Mailing Address - Street 1:5215 CROWFOOT
Mailing Address - Street 2:C O Y STEFADU MD
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48310
Mailing Address - Country:US
Mailing Address - Phone:586-268-0100
Mailing Address - Fax:586-268-5818
Practice Address - Street 1:3058 METROPOLITAN PARKWAY
Practice Address - Street 2:SUITE 108
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310
Practice Address - Country:US
Practice Address - Phone:586-268-0100
Practice Address - Fax:586-268-5818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OP22380OtherMEDICARE STUDY
OP30200Medicare PIN
OP22380OtherMEDICARE STUDY