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Organization
GATEWAY OBGYN ASSOCIATES PLLC
Active
Organization
GATEWAY OBGYN ASSOCIATES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THEODORE KEVIN GRAHAM MD (PRESIDENT)
(313) 875-4200
Entity
Organization
Contact information
Practice address
2888 W GRAND BLVD, ST. 287, DETROIT, MI 48202-2612
(313) 875-4200
Mailing address
2888 W GRAND BLVD, ST. 287, DETROIT, MI 48202-2612
(313) 875-4200
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
4301050455
MI
Other
Enumeration date
06/06/2009
Last updated
07/19/2012
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