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Organization
NORTHEAST OBGYN SC
Active
Organization
NORTHEAST OBGYN SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY P FAIT MD (PRESIDENT)
(414) 228-8888
Entity
Organization
Contact information
Practice address
7040 N PORT WASHINGTON RD, SUITE 400, GLENDALE, WI 53217-3838
(414) 228-8888
(414) 228-8390
Mailing address
7040 N PORT WASHINGTON RD, SUITE 400, GLENDALE, WI 53217-3838
(414) 228-8888
(414) 228-8390
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
NULL
207V00000X
Obstetrics & Gynecology Physician
—
WI
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Enumeration date
11/09/2006
Last updated
08/13/2021
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