Gateway OBGYN Associates PLLC

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

4301050455 Issued in MI

Legal business name

GATEWAY OBGYN ASSOCIATES PLLC

Practice address

2888 W Grand Blvd
St. 287
Detroit, MI 48202-2612

Phone

(313) 875-4200

NPI assigned

Jun 6, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Theodore Kevin Graham, MD

Title

President

Phone

(313) 875-4200

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1244246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342656000000",
    "number": "1134355902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2888 W GRAND BLVD",
            "address_2": "ST. 287",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022612",
            "telephone_number": "313-875-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2888 W GRAND BLVD",
            "address_2": "ST. 287",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022612",
            "telephone_number": "313-875-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GATEWAY OBGYN ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-06",
        "last_updated": "2012-07-19",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_middle_name": "KEVIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "313-875-4200",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": "4301050455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gateway Detroit
• Gateway Detroit East Community
• Gateway Detroit East Community Mental Health
• Gateway Detroiteast
• Gateway Detroiteast
• Gateway Pharmacy Inc.
• Gateway Vision Services, Inc. (Belmont Vision Center)
• Gateway-Detroit East (Detroit East Health Services)
• Sandra Denise Gatewood
• Raechele C. Gathers, M.D.

• Obstetrics & Gynecology Physician in Detroit, MI
• Providers in Detroit, MI by specialty
• Obstetrics & Gynecology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.