Healthcare Provider Details

I. General information

NPI: 1073176079
Provider Name (Legal Business Name): LISA CATHERINE GATES DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2251 N SQUIRREL RD STE 320
AUBURN HILLS MI
48326-4608
US

IV. Provider business mailing address

2251 N SQUIRREL RD STE 320
AUBURN HILLS MI
48326-4608
US

V. Phone/Fax

Practice location:
  • Phone: 517-882-3732
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number5101026619
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: