Healthcare Provider Details

I. General information

NPI: 1518454883
Provider Name (Legal Business Name): JUSTIN GATT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2018
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SAINT ANTOINE ST STE 2E
DETROIT MI
48201-2153
US

IV. Provider business mailing address

55 W CANFIELD ST APT 202
DETROIT MI
48201-1884
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-4832
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberX0000
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: