Healthcare Provider Details

I. General information

NPI: 1093180838
Provider Name (Legal Business Name): ELAURISS TRANSPORTATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2015
Last Update Date: 12/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4812 PARK GLEN RD
ST LOUIS PARK MN
55416-5702
US

IV. Provider business mailing address

4812 PARK GLEN RD
ST LOUIS PARK MN
55416-5702
US

V. Phone/Fax

Practice location:
  • Phone: 612-333-3333
  • Fax:
Mailing address:
  • Phone: 612-333-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name: WALEED SONBOL
Title or Position: GENERAL MANAGER
Credential:
Phone: 612-669-7389