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General NPI Number Information
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NPI Number | 1588034979
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Entity Type | Organization
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Legal Business Name | STRAIGHTWAY TRANSPORTATION, LLC
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Dates
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Enumeration Date | 09/29/2015
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Last Update Date | 09/29/2015
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Provider Practice Location Address
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Address Line | 6499 ANNE WAY
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48127-2301
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Country | US
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Telephone | 313-477-6666
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Fax |
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Provider Business Mailing Address
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Address Line | 26200 FORD RD UNIT 562
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48127-4327
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Country | US
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Telephone | 313-477-6666
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MOHAMAD IBRAHIM KAZAN
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Credential | PRESIDENT
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Telephone | 313-477-6666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | L10566
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License Number State | MI
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