Provider Demographics
NPI:1811247059
Name:GATEWAY CLINICS PLLD
Entity type:Organization
Organization Name:GATEWAY CLINICS PLLD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NASSER
Authorized Official - Middle Name:
Authorized Official - Last Name:TAGHAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-478-1100
Mailing Address - Street 1:20331 FARMINGTON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1411
Mailing Address - Country:US
Mailing Address - Phone:248-478-1100
Mailing Address - Fax:248-478-7054
Practice Address - Street 1:20331 FARMINGTON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1411
Practice Address - Country:US
Practice Address - Phone:248-478-1100
Practice Address - Fax:248-478-7054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1417979360Medicaid
MI1417979360Medicaid
ON31880Medicare PIN