Provider Demographics
NPI:1588034979
Name:STRAIGHTWAY TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:STRAIGHTWAY TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:IBRAHIM
Authorized Official - Last Name:KAZAN
Authorized Official - Suffix:
Authorized Official - Credentials:PRESIDENT
Authorized Official - Phone:313-477-6666
Mailing Address - Street 1:26200 FORD RD UNIT 562
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-4327
Mailing Address - Country:US
Mailing Address - Phone:313-477-6666
Mailing Address - Fax:
Practice Address - Street 1:6499 ANNE WAY
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2301
Practice Address - Country:US
Practice Address - Phone:313-477-6666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL10566343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)