Provider Demographics
NPI:1750999751
Name:GATEWAY MEDICAL CENTER PLLC
Entity type:Organization
Organization Name:GATEWAY MEDICAL CENTER PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SABBAGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-406-3030
Mailing Address - Street 1:22359 CHERRY HILL ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1190
Mailing Address - Country:US
Mailing Address - Phone:313-406-3030
Mailing Address - Fax:313-406-3037
Practice Address - Street 1:22359 CHERRY HILL ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1190
Practice Address - Country:US
Practice Address - Phone:313-406-3030
Practice Address - Fax:313-406-3037
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIMARY CARE OF MICHIGAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-16
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty