Provider Demographics
NPI:1104349216
Name:LOUISVILLE SLEEP LAB LLC
Entity type:Organization
Organization Name:LOUISVILLE SLEEP LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAJJAD
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMEEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-234-0766
Mailing Address - Street 1:5810 HARRODS GLEN DR
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-7650
Mailing Address - Country:US
Mailing Address - Phone:904-234-0766
Mailing Address - Fax:502-410-0484
Practice Address - Street 1:1015 DUPONT RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4610
Practice Address - Country:US
Practice Address - Phone:904-234-0766
Practice Address - Fax:502-410-0484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39870207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty