Healthcare Provider Details

I. General information

NPI: 1124714597
Provider Name (Legal Business Name): LEELOOW TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 WINNETKA AVE N STE 330
NEW HOPE MN
55427-1250
US

IV. Provider business mailing address

4000 WINNETKA AVE N STE 330
NEW HOPE MN
55427-1250
US

V. Phone/Fax

Practice location:
  • Phone: 716-292-7851
  • Fax:
Mailing address:
  • Phone: 716-292-7851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State

VIII. Authorized Official

Name: AIDARUS MOHAMED
Title or Position: OWNER
Credential:
Phone: 716-292-7851