MEDICARE: MICHIGAN MEDICAL TRANSPORT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1750242988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN MEDICAL TRANSPORT

Provider Business Mailing Address
First Line	:	1140 ABBOT RD UNIT 4274
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48826-3048
Country	:	US
Telephone Number	:	917-750-3226
Fax Number	:	917-750-3226

Provider Business Practice Location Address
First Line	:	1140 ABBOT RD UNIT 4274
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48826-3048
Country	:	US
Telephone Number	:	917-750-3226
Fax Number	:	917-750-3226

Authorized Official
Title or Position	:	DIRECTOR
Name	:	SANJA NOVAKOVIC
Credential	:	CHW,CCMA,MHA
Telephone Number	:	917-750-3226

Provider Enumeration Date	:	11/18/2025
Last Update Date	:	12/29/2025

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