=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538546080
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EZ TRANSPO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2015
-----------------------------------------------------
Last Update Date | 05/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26274 SHEAHAN DR
-----------------------------------------------------
City | DEARBORN HEIGHTS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48127-4118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-632-1000
-----------------------------------------------------
Fax | 313-945-1810
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26274 SHEAHAN DR
-----------------------------------------------------
City | DEARBORN HEIGHTS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48127-4118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-632-1000
-----------------------------------------------------
Fax | 313-945-1810
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ADAM MICHEAL FAYLI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 313-632-1000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 344600000X
-----------------------------------------------------
Taxonomy Name | Taxi
-----------------------------------------------------
License Number | F400031603523
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------