Organization
BIOSERENITY DT INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANICE SHOCK (EVP CLINICAL OPERATIONS)
(214) 532-3757
Entity
Organization
Contact information
Practice address
32100 TELEGRAPH RD, SUITE 145, BINGHAM FARMS, MI 48025
(248) 281-0151
(248) 281-0156
Mailing address
99 ROSEWOOD DR STE 245, DANVERS, MA 01923-4537
(978) 536-7400
(978) 535-9778
Taxonomy
Speciality
Code
Description
License number
State
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004251
MIDWEST HEALTH PLAN
MI
01
—
0N69430
PREFERRED HEALTHPLAN
MI
Enumeration date
08/12/2006
Last updated
05/10/2022
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