Organization
WOLVERINE SLEEP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS R GORCZYCA RRT (OWNER)
(517) 424-8286
Entity
Organization
Contact information
Practice address
411 E RUSSELL RD, SUITE 1, TECUMSEH, MI 49286-7502
(517) 424-8286
(517) 470-0296
Mailing address
411 EAST RUSSELL ROAD, SUITE 1, TECUMSEH, MI 49286-7502
(517) 424-8286
(517) 470-0296
Taxonomy
Speciality
Code
Description
License number
State
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
290D611710
BCBS OF MICHIGAN
—
Enumeration date
05/29/2008
Last updated
07/17/2009
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