Provider Demographics
NPI:1952488769
Name:LEEWAY DURABLE MEDICAL EQUIPMENT LLC.
Entity Type:Organization
Organization Name:LEEWAY DURABLE MEDICAL EQUIPMENT LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:KHURRAM
Authorized Official - Last Name:RIZVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-325-4363
Mailing Address - Street 1:5820 NORTH CANTON CENTER RD
Mailing Address - Street 2:SUITE 140-1
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2681
Mailing Address - Country:US
Mailing Address - Phone:734-325-4363
Mailing Address - Fax:248-552-1329
Practice Address - Street 1:17515 W 9 MILE RD
Practice Address - Street 2:SUITE 750
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4403
Practice Address - Country:US
Practice Address - Phone:248-552-0910
Practice Address - Fax:248-552-1329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIB66583332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI27234OtherSTATE ID NUMBER
MI1309220001Medicare ID - Type Unspecified