Provider Demographics
NPI:1457739534
Name:COMPREHENSIVE SLEEP DIAGNOSTICS
Entity type:Organization
Organization Name:COMPREHENSIVE SLEEP DIAGNOSTICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:OKTAI
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMEDOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-248-1877
Mailing Address - Street 1:18268 PARKSHORE DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-8588
Mailing Address - Country:US
Mailing Address - Phone:517-755-6888
Mailing Address - Fax:517-657-7759
Practice Address - Street 1:3515 COOLIDGE RD STE A
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8014
Practice Address - Country:US
Practice Address - Phone:517-755-6222
Practice Address - Fax:888-501-3585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301096000207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1457739534Medicaid
MI0C30925OtherBLUE CROSS
MIMI8818Medicare PIN