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Eastgate Internal Medicine Ltd
Medical Specialty Clinic/Center in Benton Harbor, Michigan
NPI 1750530473

Eastgate Internal Medicine Ltd is a Medical Specialty Clinic/Center based in Berrien Springs, MI and is specialized in Medical Specialty. Eastgate Internal Medicine Ltd practices in Benton Harbor, MI. The NPI Number for Eastgate Internal Medicine Ltd is 1750530473 and holds a License No. 4301064652 (Michigan).

The current practice location address for Eastgate Internal Medicine Ltd is 1686 Colfax Ave, Benton Harbor, MI and can be reached out via phone at 269-925-8842 and via fax at 269-925-8847.

Location: 1686 Colfax Ave, Benton Harbor, MI, 49103-1617
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1750530473
Provider Name
Eastgate Internal Medicine Ltd
Credential
Provider Entity Type
Organization
Address
1686 Colfax Ave, Benton Harbor, MI, 49103-1617
Phone Number
269-925-8842
Fax Number
269-925-8847
Provider Enumeration Date
09/18/2008
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1073694006 01 NPI NUMBER-TYPE I
4301064652 01 MI MICHIGAN MEDICAL LICENSE NUMBER
1101111252 01 MI BLUECROSS BLUESHIELD OF MICHIGAN
415194310 05 MI
institution
Provider Business Practice Location Address Details
Address
1686 Colfax Ave
City
Benton Harbor
State
Michigan
Zip
49022-7355
Phone Number
269-925-8842
Fax Number
269-925-8847
person
Provider Business Mailing Address Details
Address
1686 Colfax Ave
City
Benton Harbor
State
Michigan
Zip
49022-7355
Phone Number
269-925-8842
Fax Number
269-925-8847
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Medical Specialty
Taxonomy
261QM2500X
License No.
4301064652 (Michigan)
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).
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