Organization
SLEEP WELLNESS SOUTHSHORE, LLC
Active
Other names
The Sleep Wellness Institute, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
VERNON R BAAKE (PARTNER)
(414) 336-3000
Entity
Organization
Contact information
Practice address
100 15TH AVE, SUITE 220, SOUTH MILWAUKEE, WI 53172-1160
(414) 336-3000
(414) 336-1015
Mailing address
2356 S 102ND ST, WEST ALLIS, WI 53227-2104
(414) 336-3000
(414) 336-1015
Taxonomy
Speciality
Code
Description
License number
State
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1600270
UNITED HEALTHCARE GROUP #
WI
05
—
32890000
—
WI
01
—
391801802002
TRICARE GROUP NUMBER
WI
01
—
391801802029
ANTHEM BLUE CROSS GROUP #
WI
01
—
6758909
CIGNA SERVICE LINE PIN
WI
Enumeration date
12/08/2006
Last updated
02/19/2008
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