# EASTGATE INTERNAL MEDICINE LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750530473
- **Authorized official:** DR. JEGAN JABEZ M.D. (OWNER)
- **Authorized official phone:** (269) 925-8842

## Contact information

- **Practice address:** 1686 COLFAX AVE, BENTON HARBOR, MI 49022-7355
- **Practice address phone:** (269) 925-8842
- **Practice address fax:** (269) 925-8847
- **Mailing address:** 8734 VALLEY VIEW DR, BERRIEN SPRINGS, MI 49103-1617
- **Mailing address phone:** (269) 925-8842
- **Mailing address fax:** (269) 925-8847

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 4301064652 | MI | Yes |

## Other

- **Enumeration date:** 09/18/2008
- **Last updated:** 09/18/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1073694006 | NPI NUMBER-TYPE I | — |
| 01 | — | 1101111252 | BLUECROSS BLUESHIELD OF MICHIGAN | MI |
| 05 | — | 415194310 | — | MI |
| 01 | — | 4301064652 | MICHIGAN MEDICAL LICENSE NUMBER | MI |