Organization · NPI-2

Gateway Detroiteast

Health Maintenance Organization · Detroit, MI

NPI number1184033128
StatusActive
Last updated in NPPESAug 4, 2014

Details

NPI
1184033128
Entity type
Organization (NPI-2)
Legal business name
Gateway Detroiteast
Organization subpart
No
Enumeration date
Aug 4, 2014
Last updated
Aug 4, 2014

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
302R00000X Health Maintenance Organization6802072589MIYes

Practice location

6309 Mack Ave
Detroit, MI 48207-2302

Phone 313-921-4700 · Fax 313-921-1660

Mailing address

6309 Mack Ave
Detroit, MI 48207-2302

Phone 313-921-4700 · Fax 313-921-1660

Authorized official

Elizabeth Cichon
Clinical Director
3133313435

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