Organization
LAKESIDE GLOBAL TRANSPORT, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUSAN MARION WILLIAMS (ADMINISTRATOR)
(313) 627-9184
Entity
Organization
Contact information
Practice address
8255 2ND AVE, DETROIT, MI 48202-2405
(313) 627-9184
(313) 416-9002
Mailing address
8255 2ND AVE, DETROIT, MI 48202-2405
(313) 627-9184
(313) 416-9002
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
347C00000X
Private Vehicle
—
—
Other
Enumeration date
04/22/2019
Last updated
04/22/2019
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