Provider Demographics
NPI:1447597794
Name:DETROIT MEDICAL TRANSPORTATION LLC
Entity Type:Organization
Organization Name:DETROIT MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-569-2444
Mailing Address - Street 1:27041 SOUTHFIELD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3459
Mailing Address - Country:US
Mailing Address - Phone:248-569-2444
Mailing Address - Fax:248-569-4449
Practice Address - Street 1:27041 SOUTHFIELD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-3459
Practice Address - Country:US
Practice Address - Phone:248-569-2444
Practice Address - Fax:248-569-4449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2548343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)