Basic Information
| Provider Information | |||||||||
| NPI: | 1427235464 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SLEEP 4 SURE CO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 388320 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606388320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737678283 | ||||||||
| FaxNumber: | 7737678320 | ||||||||
| Practice Location | |||||||||
| Address1: | ONE MEDICAL CENTER DRIVE | ||||||||
| Address2: | |||||||||
| City: | GALENA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 61036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157771340 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2008 | ||||||||
| LastUpdateDate: | 06/04/2008 | ||||||||
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| AuthorizedOfficialLastName: | KOVELESKI | ||||||||
| AuthorizedOfficialFirstName: | JULES | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8157760104 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 036052720 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 036052720 | 05 | IL | MEDICAID |