Organization
GATEWAY-DETROIT EAST
Active
Other names
Detroit East Health Services
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RADWAN KHOURY PH.D (GROUP HEAD)
(313) 331-3435
Entity
Organization
Contact information
Practice address
6309 MACK AVE, DETROIT, MI 48207-2302
(313) 921-4700
Mailing address
6309 MACK AVE, DETROIT, MI 48207-2302
(313) 921-4700
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
207R00000X
Internal Medicine Physician
—
—
2084P0800X
Psychiatry Physician
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
11/04/2011
Last updated
07/30/2015
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