Organization
GREAT LAKES ACCIDENT SERVICE LTD.
Active
Organization
GREAT LAKES ACCIDENT SERVICE LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MYLES ANTHONY-ISAAC FREDERICK (CHIEF EXECUTIVE OFFICER)
(313) 452-6788
Entity
Organization
Contact information
Practice address
615 GRISWOLD ST STE 1626, DETROIT, MI 48226-3901
(877) 304-1040
Mailing address
22200 W 11 MILE RD, SOUTHFIELD, MI 48037-7136
(877) 304-1040
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
05674V
MI
Other
Enumeration date
10/03/2014
Last updated
10/03/2014
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