Healthcare Provider Details

I. General information

NPI: 1114622446
Provider Name (Legal Business Name): ITRAN LOGISTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10315 GRAND RIVER RD STE 303
BRIGHTON MI
48116-9586
US

IV. Provider business mailing address

10315 GRAND RIVER RD STE 303
BRIGHTON MI
48116-9586
US

V. Phone/Fax

Practice location:
  • Phone: 269-213-5225
  • Fax:
Mailing address:
  • Phone: 269-213-5225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: FONTAINE LAMARR YOUNG
Title or Position: CFO
Credential:
Phone: 269-213-5225