| Organization Name: | GATEWAY DETROITEAST |
| NPI Number: | 1750790234 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ELIZABETH CICHON (CLINICAL DIRETOR) |
| Mailing Address: | 6309 Mack Ave Detroit |
| State: | MI US |
| Postal Code: | 482072302 |
| Phone Number: | 3139214700 |
| Fax Number: | 3139211660 |
| NPI Enumeration Date: | 08/08/2014 |
| NPI Last Update Date: | 08/08/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 302R00000X |
| License Number: | 6803084997 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Managed Care Organizations |
| Taxonomy Classification: | Health Maintenance Organization |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) A form of health insurance in which its members prepay a premium for the HMO |