Organization
GATEWAY DETROITEAST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ELIZABETH CICHON (CLINICAL DIRETOR)
(313) 921-4700
Entity
Organization
Contact information
Practice address
6309 MACK AVE, DETROIT, MI 48207-2302
(313) 921-4700
(313) 921-1660
Mailing address
6309 MACK AVE, DETROIT, MI 48207-2302
(313) 921-4700
(313) 921-1660
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
6803084997
MI
Other
Enumeration date
08/08/2014
Last updated
08/08/2014
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