Healthcare Provider Details

I. General information

NPI: 1356279616
Provider Name (Legal Business Name): GREAT LAKES MEDICAL TRANSIT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19657 HARMAN ST
MELVINDALE MI
48122-1690
US

IV. Provider business mailing address

19657 HARMAN ST
MELVINDALE MI
48122-1690
US

V. Phone/Fax

Practice location:
  • Phone: 313-978-0496
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ABDALLAH ALI
Title or Position: MEMBER
Credential:
Phone: 313-978-0496