Organization Name: | WOLVERINE SLEEP PLLC |
NPI Number: | 1174781918 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | THOMAS R GORCZYCA (OWNER) |
Mailing Address: | 411 E Russell Rd Suite 1 Tecumseh |
State: | MI US |
Postal Code: | 492867502 |
Phone Number: | 5174248286 |
Fax Number: | 5174700296 |
NPI Enumeration Date: | 05/29/2008 |
NPI Last Update Date: | 07/17/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QS1200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Sleep Disorder Diagnostic |
Taxonomy Definition: |